Healthcare Provider Details

I. General information

NPI: 1316859523
Provider Name (Legal Business Name): TRACY JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10712 BALLANTRAYE DR STE 304
FREDERICKSBURG VA
22407-4702
US

IV. Provider business mailing address

4409 BERKLEY DR
PARTLOW VA
22534-9625
US

V. Phone/Fax

Practice location:
  • Phone: 540-748-3024
  • Fax:
Mailing address:
  • Phone: 540-748-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016724
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: