Provider Demographics
NPI:1972911246
Name:PERL, TRACY (LPC, NCC, BCPCC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:PERL
Suffix:
Gender:F
Credentials:LPC, NCC, BCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 TOLUCA RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1852
Mailing Address - Country:US
Mailing Address - Phone:917-515-7884
Mailing Address - Fax:540-602-7937
Practice Address - Street 1:238 TOLUCA RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1852
Practice Address - Country:US
Practice Address - Phone:917-515-7884
Practice Address - Fax:540-602-7937
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional