Provider Demographics
NPI:1699415281
Name:GILL, TRACY PACE (LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:PACE
Last Name:GILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:PACE
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:11 N HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-6449
Mailing Address - Country:US
Mailing Address - Phone:601-463-1862
Mailing Address - Fax:
Practice Address - Street 1:11 N HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-6449
Practice Address - Country:US
Practice Address - Phone:601-463-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional