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Individual
TRACY LEE WHITAKER
Active
Individual
TRACY LEE WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006097
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945115
—
VA
01
—
180716
HEALTHKEEPERS
VA
05
—
180716
—
VA
01
—
O85302M
SOUTHERN HEALTH
VA
05
—
O85302M
—
VA
Enumeration date
04/20/2006
Last updated
05/28/2024
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