Provider Demographics
NPI:1154476927
Name:ECKERT, TRACY MILLS (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MILLS
Last Name:ECKERT
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CAMILLE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2040
Mailing Address - Country:US
Mailing Address - Phone:860-965-7500
Mailing Address - Fax:
Practice Address - Street 1:59 E HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2215
Practice Address - Country:US
Practice Address - Phone:860-965-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YA0400X101YA0400X
CT101YP2500X101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)