Provider Demographics
NPI:1780950881
Name:REID-BARROW, TRACY A (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:REID-BARROW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 PORTER LN
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-2288
Mailing Address - Country:US
Mailing Address - Phone:347-834-1513
Mailing Address - Fax:706-925-5692
Practice Address - Street 1:730 PORTER LN
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-2288
Practice Address - Country:US
Practice Address - Phone:347-834-1513
Practice Address - Fax:706-925-5692
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07778511041C0700X
NY73 0807581041C0700X
GACSW0056151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical