Provider Demographics
NPI:1477071421
Name:JAMES, TRACY LYNETTE (LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNETTE
Last Name:JAMES
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1216
Mailing Address - Country:US
Mailing Address - Phone:252-792-8035
Mailing Address - Fax:252-792-8045
Practice Address - Street 1:607 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2645
Practice Address - Country:US
Practice Address - Phone:252-792-8035
Practice Address - Fax:252-792-8045
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0119461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty