Provider Demographics
NPI:1972283364
Name:HALL, TRACY KATHLEEN (MFT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:KATHLEEN
Last Name:HALL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S MLK, JR. BLVD.
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709
Mailing Address - Country:US
Mailing Address - Phone:229-931-2798
Mailing Address - Fax:
Practice Address - Street 1:908 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-2917
Practice Address - Country:US
Practice Address - Phone:229-931-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)