Healthcare Provider Details

I. General information

NPI: 1790462158
Provider Name (Legal Business Name): ALLISON MARIE HAMILTON PACE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S BROAD ST
WINDER GA
30680-2038
US

IV. Provider business mailing address

56 HILLCREST DR
TOCCOA GA
30577-2895
US

V. Phone/Fax

Practice location:
  • Phone: 770-246-2822
  • Fax:
Mailing address:
  • Phone: 912-655-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015868
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC015868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: