Provider Demographics
NPI:1881452209
Name:MARRERO, TRACI J (MA, APC, CAMT)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:J
Last Name:MARRERO
Suffix:
Gender:F
Credentials:MA, APC, CAMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SHELBY RAE RD NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-7584
Mailing Address - Country:US
Mailing Address - Phone:912-318-6201
Mailing Address - Fax:
Practice Address - Street 1:101 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2727
Practice Address - Country:US
Practice Address - Phone:912-876-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional