Provider Demographics
NPI:1730531799
Name:TIERRA PACE
Entity type:Organization
Organization Name:TIERRA PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR I/II
Authorized Official - Prefix:
Authorized Official - First Name:TIERRA
Authorized Official - Middle Name:LEE-ANN
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:443-485-7597
Mailing Address - Street 1:3306 STONE GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3306 STONE GATE BLVD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-4152
Practice Address - Country:US
Practice Address - Phone:443-485-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21849251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare