Healthcare Provider Details

I. General information

NPI: 1679167902
Provider Name (Legal Business Name): LINDSEY PACE LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 KENWOOD DR
HAMPTON VA
23666-3511
US

IV. Provider business mailing address

27 KENWOOD DR
HAMPTON VA
23666-3511
US

V. Phone/Fax

Practice location:
  • Phone: 757-655-5892
  • Fax:
Mailing address:
  • Phone: 757-206-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY PACE
Title or Position: OWNER
Credential: LCSW
Phone: 757-206-2824