MEDICARE: TIMOTHY PACE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver
2	101YP2500X	Professional Counselor	0701009973	VA

General Provider Information

NPI Number	:	1255833182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY PACE LPC

Provider Business Mailing Address
First Line	:	13926 HULL STREET RD # 2025
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2004
Country	:	US
Telephone Number	:	804-464-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 RUTHERS RD STE 101
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-497-9418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	09/09/2021

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Directions to “ TIMOTHY PACE LPC” Practice Location

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