Provider Demographics
NPI:1134587215
Name:DURKIN, TRACEY ANN (MA, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ANN
Last Name:DURKIN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 GREENGARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1117
Mailing Address - Country:US
Mailing Address - Phone:814-572-0127
Mailing Address - Fax:814-451-0338
Practice Address - Street 1:3806 GREENGARDEN RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1117
Practice Address - Country:US
Practice Address - Phone:814-572-0127
Practice Address - Fax:814-451-0338
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA309938OtherNATIONAL CERTIFIED COUNSELOR