Provider Demographics
NPI:1245528819
Name:VICKERS, TRACY N (LCPC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:N
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7295 BUTTERCUP RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7463
Mailing Address - Country:US
Mailing Address - Phone:703-350-8366
Mailing Address - Fax:703-243-0975
Practice Address - Street 1:7295 BUTTERCUP RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7463
Practice Address - Country:US
Practice Address - Phone:410-795-5767
Practice Address - Fax:410-795-6770
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional