Healthcare Provider Details

I. General information

NPI: 1316379282
Provider Name (Legal Business Name): TRACEY ELAINE GROUX LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23164 DRAGOON RD
LIGNUM VA
22726-2036
US

IV. Provider business mailing address

23164 DRAGOON RD
LIGNUM VA
22726-2036
US

V. Phone/Fax

Practice location:
  • Phone: 540-399-1926
  • Fax:
Mailing address:
  • Phone: 540-399-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: