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Individual
TRACY L THOMAS
Active
Individual
TRACY L THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LCDCIII
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.161575
OH
163W00000X
Registered Nurse
Primary
RN.305429
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN.305429
RN LICENSE
OH
Enumeration date
06/28/2017
Last updated
05/31/2018
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