Healthcare Provider Details

I. General information

NPI: 1619391752
Provider Name (Legal Business Name): TRACIE SMITH LMHC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 PORTSMOUTH AVE
GREENLAND NH
03840-2220
US

IV. Provider business mailing address

330 PORTSMOUTH AVE
GREENLAND NH
03840-2220
US

V. Phone/Fax

Practice location:
  • Phone: 917-940-9742
  • Fax:
Mailing address:
  • Phone: 917-940-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2698
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60432168
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: