Provider Demographics
NPI:1033671094
Name:GREGSON, TRACI MICHELLE (LPCMH)
Entity Type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:MICHELLE
Last Name:GREGSON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:M
Other - Last Name:PREVOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 CHAPMAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5426
Mailing Address - Country:US
Mailing Address - Phone:302-455-9333
Mailing Address - Fax:
Practice Address - Street 1:261 CHAPMAN RD STE 102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5426
Practice Address - Country:US
Practice Address - Phone:302-455-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0001003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health