Provider Demographics
NPI:1053138305
Name:TRACY, CHRISTINA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-4014
Mailing Address - Country:US
Mailing Address - Phone:207-263-3736
Mailing Address - Fax:
Practice Address - Street 1:3 RUTH ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-4014
Practice Address - Country:US
Practice Address - Phone:207-263-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC23998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health