Provider Demographics
NPI:1487932729
Name:WHITLEY, TRACI CATOGNI
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:CATOGNI
Last Name:WHITLEY
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 1:9518 3RD BAY ST UNIT 120
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1013
Mailing Address - Country:US
Mailing Address - Phone:760-421-8455
Mailing Address - Fax:
Practice Address - Street 1:317 OFFICE SQUARE LN STE B101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3652
Practice Address - Country:US
Practice Address - Phone:757-703-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 61824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health