Healthcare Provider Details

I. General information

NPI: 1538073010
Provider Name (Legal Business Name): TRACI SHAIN BASS LCSW, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 LANGSTON RD
PERRY GA
31069-9325
US

IV. Provider business mailing address

429 LANGSTON RD
PERRY GA
31069-9325
US

V. Phone/Fax

Practice location:
  • Phone: 478-951-9298
  • Fax:
Mailing address:
  • Phone: 478-951-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: