Healthcare Provider Details

I. General information

NPI: 1225285737
Provider Name (Legal Business Name): TRACY OPAL MANSSON M.A., LAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 WALNUT AVE APT 17
CARLSBAD CA
92008-3155
US

IV. Provider business mailing address

370 WALNUT AVE APT 17
CARLSBAD CA
92008-3155
US

V. Phone/Fax

Practice location:
  • Phone: 760-730-2254
  • Fax:
Mailing address:
  • Phone: 760-730-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLR10470924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: