Provider Demographics
NPI:1972649150
Name:TARR, TRACEY (LADC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:TARR
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BUCKSPORT RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2722
Mailing Address - Country:US
Mailing Address - Phone:207-667-6890
Mailing Address - Fax:207-667-8457
Practice Address - Street 1:710 BUCKSPORT RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2722
Practice Address - Country:US
Practice Address - Phone:207-667-6890
Practice Address - Fax:207-667-8457
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2541101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)