Healthcare Provider Details

I. General information

NPI: 1801305891
Provider Name (Legal Business Name): TRACI LYNETTE HOWARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CLEVELAND PL STE B
VIRGINIA BEACH VA
23462-6529
US

IV. Provider business mailing address

1423 NORTHFACE CT
VIRGINIA BEACH VA
23462-7430
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax: 757-233-1669
Mailing address:
  • Phone: 757-705-4184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: