Provider Demographics
NPI:1952744138
Name:KEATON-JOHNSON, TRACY LAVERNE (LCSW, MSW)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LAVERNE
Last Name:KEATON-JOHNSON
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 THIMBLE SHOALS BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4260
Mailing Address - Country:US
Mailing Address - Phone:757-768-7880
Mailing Address - Fax:757-782-2783
Practice Address - Street 1:733 THIMBLE SHOALS BLVD STE 170
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4260
Practice Address - Country:US
Practice Address - Phone:757-768-7880
Practice Address - Fax:757-782-2783
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical