Provider Demographics
NPI:1639410616
Name:SHELBY, TRACEY (LCSW, MSW, MPH)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SHELBY
Suffix:
Gender:F
Credentials:LCSW, MSW, MPH
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:SPADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MSW, MPH
Mailing Address - Street 1:2398 WATERMARK
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1326
Mailing Address - Country:US
Mailing Address - Phone:678-592-6784
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:ATLANTA VA MEDICAL CENTER
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical