Provider Demographics
NPI:1194109421
Name:HAMPTON, TRACEY MARIE (LPC)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:MARIE
Last Name:HAMPTON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:MARIE
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:480 PIERCE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5512
Mailing Address - Country:US
Mailing Address - Phone:570-406-2084
Mailing Address - Fax:570-504-1630
Practice Address - Street 1:480 PIERCE ST STE 108
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5512
Practice Address - Country:US
Practice Address - Phone:570-406-2084
Practice Address - Fax:570-504-1630
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health