Provider Demographics
NPI:1265006837
Name:WHALEY, TRACY SHERROD (RBT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SHERROD
Last Name:WHALEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DEL A RAE CIR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4111
Mailing Address - Country:US
Mailing Address - Phone:912-663-7622
Mailing Address - Fax:
Practice Address - Street 1:613 TOWNE PARK DR W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5182
Practice Address - Country:US
Practice Address - Phone:912-677-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT20133399106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician