Provider Demographics
NPI:1528463940
Name:HELLER, TRACY (PHD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 COVE RD.
Mailing Address - Street 2:BUILDING 3855, SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459
Mailing Address - Country:US
Mailing Address - Phone:757-763-3715
Mailing Address - Fax:
Practice Address - Street 1:1840 COVE ROAD
Practice Address - Street 2:BUILDING 3855, SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459
Practice Address - Country:US
Practice Address - Phone:757-763-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005077103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical