Provider Demographics
NPI:1881965440
Name:DINEEN-HUTCHINS, TRACEY (LPC, LADC)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:DINEEN-HUTCHINS
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 EKONK HILL RD
Mailing Address - Street 2:
Mailing Address - City:VOLUNTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06384-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 PENNSLYVANIA AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-3231
Practice Address - Country:US
Practice Address - Phone:860-861-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000713101YA0400X
CT000714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)