Provider Demographics
NPI:1023358355
Name:TRACY, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7945 MACARTHUR BLVD STE 214
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1634
Practice Address - Country:US
Practice Address - Phone:301-987-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist