Individual
IVAN VEGA PACHECO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMHC, LPC
Contact information
Practice address
322 N SHORE DR BLDG 1B, SUITE 200, PITTSBURGH, PA 15212-5875
(646) 941-7645
(929) 596-7897
Mailing address
13800 PANAMA CITY BEACH PKWY STE 106D, PMB# 110, PANAMA CITY BEACH, FL 32407-2866
(850) 328-5635
(717) 259-3805
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MH25101
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
PC015320
PA
101YM0800X
Mental Health Counselor
Primary
MH25101
FL
101YP2500X
Professional Counselor
PC015320
PA
Other
Enumeration date
01/31/2023
Last updated
02/11/2025
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