Provider Demographics
NPI:1801219191
Name:ANTHONY, TRACY (LPCA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 TOWNSEND FARM DR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 S ELM ST
Practice Address - Street 2:SUITE 413
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2696
Practice Address - Country:US
Practice Address - Phone:336-822-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10329101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor