Provider Demographics
NPI:1083370811
Name:NEVILLE, TRACI LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEIGH
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 KETCHAM RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4916
Mailing Address - Country:US
Mailing Address - Phone:484-903-5189
Mailing Address - Fax:
Practice Address - Street 1:78 KETCHAM RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4916
Practice Address - Country:US
Practice Address - Phone:484-903-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00566700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health