Healthcare Provider Details

I. General information

NPI: 1619516689
Provider Name (Legal Business Name): SARAH M PACE CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E MARKET ST
WARREN OH
44483-6605
US

IV. Provider business mailing address

620 W 44TH ST
ASHTABULA OH
44004-6812
US

V. Phone/Fax

Practice location:
  • Phone: 330-647-6767
  • Fax: 330-919-9700
Mailing address:
  • Phone: 440-462-8020
  • Fax: 440-538-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number172341
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: