Healthcare Provider Details

I. General information

NPI: 1821313602
Provider Name (Legal Business Name): TRACY LYNETTE CARR-MARCEL M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 COUNTRY CLUB DR
HAMPSTEAD NC
28443-8028
US

IV. Provider business mailing address

111 S RAILROAD AVE
DUNN NC
28334-4853
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-5223
  • Fax: 910-270-5414
Mailing address:
  • Phone: 910-892-0027
  • Fax: 910-892-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5074
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: