Provider Demographics
NPI:1306208400
Name:CAIN, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 E CHURCHVILLE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3442
Mailing Address - Country:US
Mailing Address - Phone:410-893-4600
Mailing Address - Fax:443-640-4358
Practice Address - Street 1:431 FAIRMONT PLACE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1116
Practice Address - Country:US
Practice Address - Phone:418-934-1600
Practice Address - Fax:443-640-4358
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor