Provider Demographics
NPI:1457815136
Name:DASHER, TRACY ELLEN
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELLEN
Last Name:DASHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-2908
Mailing Address - Country:US
Mailing Address - Phone:863-266-1921
Mailing Address - Fax:
Practice Address - Street 1:24 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-2908
Practice Address - Country:US
Practice Address - Phone:863-266-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health