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General NPI Number Information
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NPI Number | 1306921614
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Entity Type | Individual
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Provider Name | DIANA LYNN TRACEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8101 HINSON FARM RD SUITE 117
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3403
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Country | US
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Telephone | 571-245-0054
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Fax |
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Provider Business Mailing Address
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Address Line | 4108 OLD MILL RD
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2817
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Country | US
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Telephone | 703-780-9385
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904002539
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License Number State | VA
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