Healthcare Provider Details

I. General information

NPI: 1457830317
Provider Name (Legal Business Name): CHRISTOPHER H MACE PHD, MEPP, MED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

IV. Provider business mailing address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-0022
  • Fax: 202-217-2330
Mailing address:
  • Phone: 24-760-0222
  • Fax: 202-217-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number009335804I
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberNIH-USA
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number009335804I
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberBH23885
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: