Provider Demographics
NPI:1124101688
Name:FUTCH, TRACY (PHD, MS, CGC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FUTCH
Suffix:
Gender:F
Credentials:PHD, MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 PEACHWAY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5392
Mailing Address - Country:US
Mailing Address - Phone:919-361-7790
Mailing Address - Fax:
Practice Address - Street 1:1912 ALEXANDER DRIVE
Practice Address - Street 2:GENETIC SERVICES
Practice Address - City:RESEARCH TRIANGLE PARK
Practice Address - State:NC
Practice Address - Zip Code:27709
Practice Address - Country:US
Practice Address - Phone:919-361-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005092OtherABGC CERTIFICATION