Provider Demographics
NPI:1962535005
Name:PRICE, TRACY C (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:PRICE
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4105
Mailing Address - Country:US
Mailing Address - Phone:252-634-3507
Mailing Address - Fax:
Practice Address - Street 1:3503 KAREN ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4105
Practice Address - Country:US
Practice Address - Phone:252-634-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2825101YP2500X
NC51969 - NCC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional