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NPI Code Detail

MEDICARE: MRS. TRACY ELLEN CARTER M.S., L.C.P.C.

MEDICARE: MRS. TRACY ELLEN CARTER M.S., L.C.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLC2125MD
2101YP2500XProfessional Counselor1916WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114961141
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY ELLEN CARTER M.S., L.C.P.C.
Provider Business Mailing Address
First Line : 58 GIRTH LN
Second Line :
City : SHENANDOAH JUNCTION
State : WV
Zip : 25442-4032
Country : US
Telephone Number : 410-598-3186
Fax Number : 304-725-9096
Provider Business Practice Location Address
First Line : 126 E BURKE ST
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-4302
Country : US
Telephone Number : 410-598-3186
Fax Number : 304-725-9096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 08/30/2021

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