Provider Demographics
NPI:1881752582
Name:BUSHKOFF, TRACY GINTER (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:GINTER
Last Name:BUSHKOFF
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 N TAZEWELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4556
Mailing Address - Country:US
Mailing Address - Phone:703-243-3432
Mailing Address - Fax:703-532-2787
Practice Address - Street 1:3801 FAIRFAX DR STE 62
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-243-3432
Practice Address - Fax:703-532-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health