Provider Demographics
NPI:1750308508
Name:CARTER, TRACY (LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17628 STONEGAIT CT
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-2264
Mailing Address - Country:US
Mailing Address - Phone:703-220-8563
Mailing Address - Fax:
Practice Address - Street 1:17 ROYAL ST SW STE 201
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2912
Practice Address - Country:US
Practice Address - Phone:703-303-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA832788000OtherMAGELLAN
VA010207436Medicaid