Provider Demographics
NPI:1871825794
Name:FLYNN, TRACY ANN (MS ED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS ED, LPC
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:MILLSPAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:1725 S MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5012
Mailing Address - Country:US
Mailing Address - Phone:919-556-6501
Mailing Address - Fax:919-556-4933
Practice Address - Street 1:1725 S MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5012
Practice Address - Country:US
Practice Address - Phone:919-556-6501
Practice Address - Fax:919-556-4933
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health