Provider Demographics
NPI:1124794672
Name:EPES, TRACIE (MS, EDS, LPC)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:EPES
Suffix:
Gender:F
Credentials:MS, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 GEORGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1220
Mailing Address - Country:US
Mailing Address - Phone:336-601-4606
Mailing Address - Fax:
Practice Address - Street 1:8300 GEORGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1220
Practice Address - Country:US
Practice Address - Phone:336-601-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health