Provider Demographics
NPI:1700197464
Name:HOLLINGWORTH, TRACY J (PHD, LPCC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:J
Last Name:HOLLINGWORTH
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2617
Mailing Address - Country:US
Mailing Address - Phone:505-705-0571
Mailing Address - Fax:505-503-1617
Practice Address - Street 1:2107 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2617
Practice Address - Country:US
Practice Address - Phone:505-705-0571
Practice Address - Fax:505-503-1617
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0144631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health