Provider Demographics
NPI:1619573623
Name:SCOTT, TRACEY RASEY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:RASEY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ANNE
Other - Last Name:RASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 FOREST LAKES DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7558
Mailing Address - Country:US
Mailing Address - Phone:757-323-6861
Mailing Address - Fax:
Practice Address - Street 1:700 DWYER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-6921
Practice Address - Country:US
Practice Address - Phone:757-615-3003
Practice Address - Fax:888-851-5298
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst