Provider Demographics
NPI:1528211901
Name:COHN, TRACY J (PHD)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:J
Last Name:COHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 FAIRVIEW AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5720
Mailing Address - Country:US
Mailing Address - Phone:540-230-5958
Mailing Address - Fax:
Practice Address - Street 1:125 BROAD ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3201
Practice Address - Country:US
Practice Address - Phone:540-674-4506
Practice Address - Fax:540-674-4507
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528211901Medicaid