Provider Demographics
NPI:1023359593
Name:DEMERCHANT, TRACI LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:DEMERCHANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10712 BALLANTRAYE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4702
Mailing Address - Country:US
Mailing Address - Phone:540-242-8970
Mailing Address - Fax:540-710-9299
Practice Address - Street 1:10712 BALLANTRAYE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4702
Practice Address - Country:US
Practice Address - Phone:540-242-8970
Practice Address - Fax:540-710-9299
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040076381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical