Provider Demographics
NPI:1306020748
Name:ESTES, TRACIE JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:JEAN
Last Name:ESTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 AVENUE G APT 4
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5919
Mailing Address - Country:US
Mailing Address - Phone:310-316-4584
Mailing Address - Fax:
Practice Address - Street 1:407 AVENUE G APT 4
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5919
Practice Address - Country:US
Practice Address - Phone:310-316-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS177581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical