Provider Demographics
NPI:1063637163
Name:VANBUREN, TRACY (MS)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 APPLEDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-649-5063
Mailing Address - Fax:
Practice Address - Street 1:8520 CLIFF CAMERON DRIVE
Practice Address - Street 2:SUITE 460 EXCEL PERSONEL DEVELOPMENT
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269
Practice Address - Country:US
Practice Address - Phone:704-510-1535
Practice Address - Fax:704-940-8060
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2299103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist