Provider Demographics
NPI:1427296656
Name:PACE, KELVIN JERMAINE
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:JERMAINE
Last Name:PACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 MINNESOTA DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3673
Mailing Address - Country:US
Mailing Address - Phone:907-279-9278
Mailing Address - Fax:
Practice Address - Street 1:3003 MINNESOTA DR STE 204
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3673
Practice Address - Country:US
Practice Address - Phone:907-279-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health