Provider Demographics
NPI:1811619844
Name:BRACEY, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BRACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LITTLE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6774
Mailing Address - Country:US
Mailing Address - Phone:919-210-7175
Mailing Address - Fax:
Practice Address - Street 1:106 WORTHAM CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-4500
Practice Address - Country:US
Practice Address - Phone:252-320-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical