Provider Demographics
NPI:1467138164
Name:DORSEY, TRACEY AMINA WOODS (MA,LMHP,LPC-RESIDENT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:AMINA WOODS
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MA,LMHP,LPC-RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 HEAVENLY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8954
Mailing Address - Country:US
Mailing Address - Phone:804-385-1265
Mailing Address - Fax:
Practice Address - Street 1:8024 HEAVENLY VALLEY DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-8954
Practice Address - Country:US
Practice Address - Phone:804-385-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health