Provider Demographics
NPI:1093525883
Name:PACE, JAKI LARUE
Entity type:Individual
Prefix:
First Name:JAKI
Middle Name:LARUE
Last Name:PACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15987 US HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-2557
Mailing Address - Country:US
Mailing Address - Phone:910-789-4794
Mailing Address - Fax:
Practice Address - Street 1:15987 US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-2557
Practice Address - Country:US
Practice Address - Phone:910-789-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool