Provider Demographics
NPI:1376518852
Name:BOYER-MATTHEWS, TRACY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BOYER-MATTHEWS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4117
Mailing Address - Country:US
Mailing Address - Phone:910-791-5171
Mailing Address - Fax:910-791-5777
Practice Address - Street 1:3415 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4117
Practice Address - Country:US
Practice Address - Phone:910-791-5171
Practice Address - Fax:910-791-5777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3735101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7582409OtherAETNA
NC1281JOtherBCBS
NC206019OtherCOMPSYCH