Provider Demographics
NPI:1316104656
Name:CHESTER, TRACI D (LCSW)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:D
Last Name:CHESTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:DAVIS
Other - Last Name:CHESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1540 STEVENSON CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-9786
Mailing Address - Country:US
Mailing Address - Phone:760-855-2528
Mailing Address - Fax:760-855-2528
Practice Address - Street 1:1540 STEVENSON CT
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-9786
Practice Address - Country:US
Practice Address - Phone:760-855-2528
Practice Address - Fax:760-855-2528
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS # 204621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical