Provider Demographics
NPI:1871003814
Name:VALENTINE, TRACYE FREEMAN
Entity Type:Individual
Prefix:MS
First Name:TRACYE
Middle Name:FREEMAN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1106 2000 MALLORY LN, STE 290
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:38067
Mailing Address - Country:US
Mailing Address - Phone:615-326-9539
Mailing Address - Fax:731-213-1837
Practice Address - Street 1:#1106-2000 MALLORY LANE
Practice Address - Street 2:STE 290
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-326-9539
Practice Address - Fax:731-213-1837
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5903101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional