Provider Demographics
NPI:1821313602
Name:CARR-MARCEL, TRACY LYNETTE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNETTE
Last Name:CARR-MARCEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4853
Mailing Address - Country:US
Mailing Address - Phone:910-892-0027
Mailing Address - Fax:910-892-0029
Practice Address - Street 1:2778 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8028
Practice Address - Country:US
Practice Address - Phone:910-270-5223
Practice Address - Fax:910-270-5414
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist