Provider Demographics
NPI:1700054319
Name:SIMPSON, TRACEY ADELE (LPC,MAC,NCC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ADELE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LPC,MAC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 JUSTIN WAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1476
Mailing Address - Country:US
Mailing Address - Phone:770-339-7667
Mailing Address - Fax:
Practice Address - Street 1:544 MULBERRY ST STE 105
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8249
Practice Address - Country:US
Practice Address - Phone:770-339-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional