Provider Demographics
NPI:1982924361
Name:CARTER, TRACEY TAYLOR (LPC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:TAYLOR
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 BIG DOG TRL
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4998
Mailing Address - Country:US
Mailing Address - Phone:706-284-2752
Mailing Address - Fax:706-364-0401
Practice Address - Street 1:1265 INTERSTATE PKWY STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6481
Practice Address - Country:US
Practice Address - Phone:706-751-7558
Practice Address - Fax:706-364-0401
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006844101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor