Provider Demographics
NPI:1922755974
Name:WILLIAMS, TRACI (LPCC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2920
Mailing Address - Country:US
Mailing Address - Phone:818-601-8330
Mailing Address - Fax:
Practice Address - Street 1:804 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2920
Practice Address - Country:US
Practice Address - Phone:818-601-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional