Provider Demographics
NPI:1972158574
Name:TRACY, RYAN DAVID (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DAVID
Last Name:TRACY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 RITCHIE HWY STE 1020
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4193
Mailing Address - Country:US
Mailing Address - Phone:410-431-5111
Mailing Address - Fax:410-431-5112
Practice Address - Street 1:819 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4197
Practice Address - Country:US
Practice Address - Phone:410-431-5111
Practice Address - Fax:410-431-5112
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional