Provider Demographics
NPI:1952520967
Name:HOWARD, TRACY YVETTE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:YVETTE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5694 GREY FOX CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1610
Mailing Address - Country:US
Mailing Address - Phone:678-438-6793
Mailing Address - Fax:678-620-2149
Practice Address - Street 1:5694 GREY FOX CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1610
Practice Address - Country:US
Practice Address - Phone:678-438-6793
Practice Address - Fax:678-620-2149
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00652132AMedicaid