Provider Demographics
NPI:1881920916
Name:GANAWAY, TRACI (LCSW-C)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:
Last Name:GANAWAY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9543 TESSA LN
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3276
Mailing Address - Country:US
Mailing Address - Phone:410-493-9411
Mailing Address - Fax:410-356-1583
Practice Address - Street 1:9543 TESSA LN
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3276
Practice Address - Country:US
Practice Address - Phone:410-493-9411
Practice Address - Fax:410-356-1583
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121781041C0700X
DCLC500781361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical