MEDICARE: TATJANA ESTEP RAYCROFT LCSW, MAC

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	CSW003760	GA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	507545

General Provider Information

NPI Number	:	1568797173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATJANA ESTEP RAYCROFT LCSW, MAC

Provider Business Mailing Address
First Line	:	234 CENTRAL HOSPITAL RD BLDG 329
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-6003
Country	:	US
Telephone Number	:	706-787-5392
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 CENTRAL HOSPITAL RD BLDG 329
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-6003
Country	:	US
Telephone Number	:	706-787-5392
Fax Number	:

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

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	02/28/2025

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