Provider Demographics
NPI:1295417301
Name:DOTTERMAN, TRACY ANN (MS, ED, LPA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:DOTTERMAN
Suffix:
Gender:
Credentials:MS, ED, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KEISLER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9322
Mailing Address - Country:US
Mailing Address - Phone:919-646-2627
Mailing Address - Fax:
Practice Address - Street 1:501 KEISLER DR STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9322
Practice Address - Country:US
Practice Address - Phone:919-646-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5856103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist