Provider Demographics
NPI:1043374994
Name:HALL, TRACIE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TRACIE
Other - Middle Name:L
Other - Last Name:HALL-BURKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, DBH
Mailing Address - Street 1:2020 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-3120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3120
Practice Address - Country:US
Practice Address - Phone:916-542-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26120104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker