Provider Demographics
NPI:1376844621
Name:DAVIS, TRACEY LEE (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:LEE
Last Name:DAVIS
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 1:9401 MCKNIGHT RD
Mailing Address - Street 2:STE. 304-B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6000
Mailing Address - Country:US
Mailing Address - Phone:412-367-0575
Mailing Address - Fax:412-367-0582
Practice Address - Street 1:9401 MCKNIGHT RD
Practice Address - Street 2:STE. 304-B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6000
Practice Address - Country:US
Practice Address - Phone:412-367-0575
Practice Address - Fax:412-367-0582
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional