Provider Demographics
NPI: | 1659462794 |
---|---|
Name: | POSTON, TRACI LEIGH (MS, LMHC, CAP) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | TRACI |
Middle Name: | LEIGH |
Last Name: | POSTON |
Suffix: | |
Gender: | F |
Credentials: | MS, LMHC, CAP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 463 RUSH PARK CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | MARY ESTHER |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32569-2405 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 850-581-2884 |
Mailing Address - Fax: | 850-581-0408 |
Practice Address - Street 1: | 463 RUSH PARK CIR |
Practice Address - Street 2: | |
Practice Address - City: | MARY ESTHER |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32569-2405 |
Practice Address - Country: | US |
Practice Address - Phone: | 850-581-2884 |
Practice Address - Fax: | 850-581-0408 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-27 |
Last Update Date: | 2016-02-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 2047L | 101YA0400X |
FL | 5485 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 761970700 | Medicaid |