Provider Demographics
NPI:1831450493
Name:MORROW, TRACI SCOTT (LPC, LCAS, CRC)
Entity type:Individual
Prefix:MR
First Name:TRACI
Middle Name:SCOTT
Last Name:MORROW
Suffix:
Gender:M
Credentials:LPC, LCAS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 SACCO ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3059
Mailing Address - Country:US
Mailing Address - Phone:704-890-2192
Mailing Address - Fax:704-973-9287
Practice Address - Street 1:413 W MAIN AVE STE 120
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4237
Practice Address - Country:US
Practice Address - Phone:704-890-2192
Practice Address - Fax:704-973-9287
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1939101YA0400X
NC8763101YM0800X
NC00114032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional