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General NPI Number Information
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NPI Number | 1063637163
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Entity Type | Individual
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Provider Name | TRACY VANBUREN MS
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8520 CLIFF CAMERON DRIVE SUITE 460 EXCEL PERSONEL DEVELOPMENT
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City | CHARLOTTE
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State | NC
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Zip | 28269
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Country | US
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Telephone | 704-510-1535
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Fax | 704-940-8060
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Provider Business Mailing Address
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Address Line | 8427 APPLEDALE DRIVE
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City | CHARLOTTE
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State | NC
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Zip | 28262
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Country | US
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Telephone | 704-649-5063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NC2299
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License Number State | NC
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