Provider Demographics
NPI:1851080295
Name:MOORE, TRACY SHERRILLE COPELAND (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SHERRILLE COPELAND
Last Name:MOORE
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 1:3119 FOX CHASE DR., MIDLOTHIAN VA 23112
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3119
Mailing Address - Country:US
Mailing Address - Phone:804-888-2813
Mailing Address - Fax:
Practice Address - Street 1:3119 FOX CHASE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4474
Practice Address - Country:US
Practice Address - Phone:804-888-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040151281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical