| NPI | 1073523890 |
|---|---|
| Former Name | HEDDIE VIRGINIA TRACY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000801) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 000801) |
| 103TC1900X Psychologist, Counseling (Licence: NY 000801) | |
| 103T00000X Psychologist (Licence: NY 000801) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 000801) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |