Provider Demographics
NPI:1578810206
Name:DAVIS, TRACEY A (MSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 WINDY PINE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-6637
Mailing Address - Country:US
Mailing Address - Phone:850-212-1403
Mailing Address - Fax:
Practice Address - Street 1:2509 BARRINGTON CIR
Practice Address - Street 2:SUITE 116
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6800
Practice Address - Country:US
Practice Address - Phone:850-421-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32-0381467104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker