Provider Demographics
NPI:1669837969
Name:CARMICHAEL, TRACY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:CARMICHAEL
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 1:715 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2030
Mailing Address - Country:US
Mailing Address - Phone:707-358-5252
Mailing Address - Fax:770-460-2463
Practice Address - Street 1:715 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2030
Practice Address - Country:US
Practice Address - Phone:770-358-5252
Practice Address - Fax:707-460-2463
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional