Healthcare Provider Details

I. General information

NPI: 1396656310
Provider Name (Legal Business Name): TRACI ARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 OHEAR AVE STE 100
NORTH CHARLESTON SC
29405-5091
US

IV. Provider business mailing address

515 FERN TREE DR
SUMMERVILLE SC
29486-2443
US

V. Phone/Fax

Practice location:
  • Phone: 843-955-7860
  • Fax:
Mailing address:
  • Phone: 843-955-7860
  • Fax: 843-543-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: