Healthcare Provider Details

I. General information

NPI: 1821276031
Provider Name (Legal Business Name): DAWN PACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 23090
JACKSON MS
39225-3090
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-1362
  • Fax:
Mailing address:
  • Phone: 601-973-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1259
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: