Provider Demographics
NPI:1356773659
Name:TRACY-PRIEBOY, JULIE AIMEE-ADELE (LGSW, MS)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:AIMEE-ADELE
Last Name:TRACY-PRIEBOY
Suffix:
Gender:F
Credentials:LGSW, MS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:AIMEE-ADELE
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW, MS
Mailing Address - Street 1:GREENBRIER ACADEMY
Mailing Address - Street 2:P.O. BOX 798
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910
Mailing Address - Country:US
Mailing Address - Phone:304-445-7790
Mailing Address - Fax:
Practice Address - Street 1:158 ACADEMY DR.
Practice Address - Street 2:GREENBRIER ACADEMY
Practice Address - City:PENCE SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24962
Practice Address - Country:US
Practice Address - Phone:304-445-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009444041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical