Provider Demographics
NPI:1639591399
Name:RICHARDS, TRACI (LPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GAINSBOROUGH SQ STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1706
Mailing Address - Country:US
Mailing Address - Phone:757-410-2287
Mailing Address - Fax:757-410-7747
Practice Address - Street 1:112 GAINSBOROUGH SQ STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1706
Practice Address - Country:US
Practice Address - Phone:757-410-2287
Practice Address - Fax:757-410-7747
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional