Healthcare Provider Details

I. General information

NPI: 1245528819
Provider Name (Legal Business Name): TRACY N. VICKERS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7295 BUTTERCUP RD
SYKESVILLE MD
21784-7463
US

IV. Provider business mailing address

7295 BUTTERCUP RD
SYKESVILLE MD
21784-7463
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-5767
  • Fax: 410-795-6770
Mailing address:
  • Phone: 703-350-8366
  • Fax: 703-243-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3901
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: