Provider Demographics
NPI:1851160881
Name:TAYLOR, TRACEY ALSTON (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ALSTON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-9361
Mailing Address - Country:US
Mailing Address - Phone:202-316-5518
Mailing Address - Fax:
Practice Address - Street 1:5900 CHURCH DR
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-9361
Practice Address - Country:US
Practice Address - Phone:202-316-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional