Provider Demographics
NPI:1659739381
Name:MCDANIEL, TRACEY G (LPC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:G
Last Name:MCDANIEL
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 1:129 DENBY CIR
Mailing Address - Street 2:P.O. BOX 291814
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 DENBY CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7785
Practice Address - Country:US
Practice Address - Phone:803-586-5889
Practice Address - Fax:803-728-0101
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional