Provider Demographics
NPI:1407514581
Name:CAIN, TRACEY ELLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ELLEN
Last Name:CAIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N COURTHOUSE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4064
Mailing Address - Country:US
Mailing Address - Phone:804-210-2402
Mailing Address - Fax:804-302-6436
Practice Address - Street 1:611 N COURTHOUSE RD STE 130
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4064
Practice Address - Country:US
Practice Address - Phone:804-210-2402
Practice Address - Fax:804-302-6436
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical