Provider Demographics
NPI:1114961141
Name:CARTER, TRACY ELLEN (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ELLEN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GIRTH LN
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4032
Mailing Address - Country:US
Mailing Address - Phone:410-598-3186
Mailing Address - Fax:304-725-9096
Practice Address - Street 1:126 E BURKE ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4302
Practice Address - Country:US
Practice Address - Phone:410-598-3186
Practice Address - Fax:304-725-9096
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2125101YP2500X
WV1916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409607001Medicaid
MD409607000Medicaid