Provider Demographics
NPI:1225174196
Name:ELSENRAAT, TRACY (MA, LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ELSENRAAT
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4082
Mailing Address - Country:US
Mailing Address - Phone:910-545-5674
Mailing Address - Fax:
Practice Address - Street 1:2507 N MARINE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6211
Practice Address - Country:US
Practice Address - Phone:910-219-4100
Practice Address - Fax:910-219-4104
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health