MEDICARE: TRAKECHA MARROW SOUTH MSW

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417814153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAKECHA MARROW SOUTH MSW

Provider Business Mailing Address
First Line	:	3630 WHITE HOUSE RD
Second Line	:
City	:	NELSON
State	:	VA
Zip	:	24580-3922
Country	:	US
Telephone Number	:	434-222-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	943 W ANDREWS AVE # K1
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-2516
Country	:	US
Telephone Number	:	919-449-7059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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