Provider Demographics
NPI:1326188525
Name:TRACY, DALE ELIZABETH (LCPC)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:ELIZABETH
Last Name:TRACY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E CHESAPEAKE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5338
Mailing Address - Country:US
Mailing Address - Phone:410-836-9622
Mailing Address - Fax:410-836-9632
Practice Address - Street 1:101 E CHESAPEAKE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5338
Practice Address - Country:US
Practice Address - Phone:410-836-9622
Practice Address - Fax:410-836-9632
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO 893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1X84OtherBCBS PPO
MD7183355OtherAETNA PROVIDER
MD223697OtherCOMPSYCH PROVIDER
MDG5120001OtherBCBS DC PROVIDER