Provider Demographics
NPI:1285374595
Name:PACE, ALLISON (LADC, MSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:LADC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5423
Mailing Address - Country:US
Mailing Address - Phone:860-578-2449
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2701
Practice Address - Country:US
Practice Address - Phone:860-578-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000898101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)