Provider Demographics
NPI:1093370587
Name:WHITE, TRACY (LCPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0016
Mailing Address - Country:US
Mailing Address - Phone:410-614-4384
Mailing Address - Fax:410-614-0973
Practice Address - Street 1:401 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0016
Practice Address - Country:US
Practice Address - Phone:410-614-4384
Practice Address - Fax:410-614-0973
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health