Provider Demographics
NPI:1992419196
Name:PACE SYNERVATIONS LLC
Entity type:Organization
Organization Name:PACE SYNERVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:769-251-5751
Mailing Address - Street 1:350 W WOODROW WILSON AVE STE 3140
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7664
Mailing Address - Country:US
Mailing Address - Phone:769-251-5751
Mailing Address - Fax:
Practice Address - Street 1:350 W WOODROW WILSON AVE STE 3140
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7664
Practice Address - Country:US
Practice Address - Phone:769-251-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty