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General NPI Number Information
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NPI Number | 1851803043
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Entity Type | Individual
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Provider Name | TRACYE LYNNE GARRETT-HERNDON LPC
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Gender | Female
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Dates
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Enumeration Date | 10/29/2017
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Last Update Date | 10/29/2017
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Provider Practice Location Address
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Address Line | 4601 CONNECTICUT AVE NW APT 110
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City | WASHINGTON
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State | DC
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Zip | 20008-5701
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Country | US
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Telephone | 240-476-2579
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 CONNECTICUT AVE NW APT 110
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City | WASHINGTON
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State | DC
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Zip | 20008-5701
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Country | US
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Telephone | 240-476-2579
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 508458
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC95
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SC1230
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License Number State | MD
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