Provider Demographics
NPI:1518470749
Name:DOMINICK, TRACI ANN (MSW, VSP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:DOMINICK
Suffix:
Gender:F
Credentials:MSW, VSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 HUMAN SERVICES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7548
Mailing Address - Country:US
Mailing Address - Phone:864-833-6500
Mailing Address - Fax:864-833-6905
Practice Address - Street 1:219 HUMAN SERVICES RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7548
Practice Address - Country:US
Practice Address - Phone:864-833-6500
Practice Address - Fax:864-833-6905
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor