Provider Demographics
NPI:1538486642
Name:BRACEY, TANYA (MS, CADC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BRACEY
Suffix:
Gender:F
Credentials:MS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1422
Mailing Address - Country:US
Mailing Address - Phone:302-377-4105
Mailing Address - Fax:
Practice Address - Street 1:503 W 9TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1401
Practice Address - Country:US
Practice Address - Phone:302-377-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE230-9133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)