Provider Demographics
NPI:1740582345
Name:PETERSON, TRACEY (MBA)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBA
Mailing Address - Street 1:234 KETTERING RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27263-1759
Mailing Address - Country:US
Mailing Address - Phone:336-681-2753
Mailing Address - Fax:
Practice Address - Street 1:234 KETTERING RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1759
Practice Address - Country:US
Practice Address - Phone:336-681-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health