Provider Demographics
NPI:1225803380
Name:SCARBOROUGH, TRACIE N (LPCA)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:N
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 CALVERT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2624
Mailing Address - Country:US
Mailing Address - Phone:864-923-0775
Mailing Address - Fax:
Practice Address - Street 1:703 CALVERT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2624
Practice Address - Country:US
Practice Address - Phone:864-923-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty