Provider Demographics
NPI:1487806915
Name:DAVIS, TRACEY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:A
Last Name:DAVIS
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 1:3100 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3537
Mailing Address - Country:US
Mailing Address - Phone:901-454-9233
Mailing Address - Fax:
Practice Address - Street 1:3100 WALNUT GROVE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3537
Practice Address - Country:US
Practice Address - Phone:901-454-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical