Provider Demographics
NPI:1679703821
Name:TRACEY-MILLER, TISHA L (MS, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:TISHA
Middle Name:L
Last Name:TRACEY-MILLER
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:N SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-0582
Mailing Address - Country:US
Mailing Address - Phone:401-241-3344
Mailing Address - Fax:888-456-2467
Practice Address - Street 1:402 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-1006
Practice Address - Country:US
Practice Address - Phone:717-624-2300
Practice Address - Fax:410-751-1206
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional