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General NPI Number Information
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NPI Number | 1730531799
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Entity Type | Organization
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Legal Business Name | TIERRA PACE
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 3306 STONE GATE BLVD
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City | ELKTON
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State | MD
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Zip | 21921-4152
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Country | US
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Telephone | 443-485-7597
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 STONE GATE BLVD
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City | ELKTON
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State | MD
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Zip | 21921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COUNSELOR I/II
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Name | TIERRA LEE-ANN PACE
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Credential | LGSW
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Telephone | 443-485-7597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 21849
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License Number State | MD
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