Provider Demographics
NPI:1790182251
Name:CHARLES, TRACY D'ANDREA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:D'ANDREA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BETHESDA PL STE 201
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3324
Mailing Address - Country:US
Mailing Address - Phone:336-793-5718
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHESDA PL STE 201
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3324
Practice Address - Country:US
Practice Address - Phone:336-793-5718
Practice Address - Fax:336-790-6770
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0098201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical