Provider Demographics
NPI:1194141408
Name:HALL, TRACIE SUZETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:SUZETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PARK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1922
Mailing Address - Country:US
Mailing Address - Phone:276-679-1045
Mailing Address - Fax:276-679-1046
Practice Address - Street 1:616 PARK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1922
Practice Address - Country:US
Practice Address - Phone:276-679-1045
Practice Address - Fax:276-679-1047
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040084441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical