Provider Demographics
NPI:1659301448
Name:PIRRI, TRACI W
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:W
Last Name:PIRRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 OAKSHYRE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-0701
Mailing Address - Country:US
Mailing Address - Phone:919-368-5921
Mailing Address - Fax:919-871-0575
Practice Address - Street 1:3900 BARRETT DR
Practice Address - Street 2:SUITE 311-F
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6641
Practice Address - Country:US
Practice Address - Phone:919-368-5921
Practice Address - Fax:919-871-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106201Medicaid
NC6106201Medicaid