Individual
HATTIE M TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW, LCDCIII
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
081003
OH
104100000X
Social Worker
Primary
I.0900274
OH
Other
Enumeration date
04/16/2007
Last updated
02/07/2012
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