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NPI Code Detail

MEDICARE: TRACY LEIGH HOPKINS MRC, LICDC-CS, SAP

MEDICARE: TRACY LEIGH HOPKINS MRC, LICDC-CS, SAP
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
1101YA0400XAddiction (Substance Use Disorder) Counselor051012OH

General Provider Information

NPI Number : 1700174208
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LEIGH HOPKINS MRC, LICDC-CS, SAP
Provider Business Mailing Address
First Line : 815 S SOUTH ST
Second Line : P.O. BOX 1038
City : WILMINGTON
State : OH
Zip : 45177-2755
Country : US
Telephone Number : 855-553-9355
Fax Number :
Provider Business Practice Location Address
First Line : 815 S SOUTH ST
Second Line : 815 SOUTH SOUTH STREET
City : WILMINGTON
State : OH
Zip : 45177-2755
Country : US
Telephone Number : 855-553-9355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2011
Last Update Date : 06/10/2016

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