Individual
TRACY WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
66 PAVILION AVE, PROVIDENCE, RI 02905-1522
(401) 461-9110
(401) 461-9194
Mailing address
66 PAVILION AVE, PROVIDENCE, RI 02905-1522
(401) 461-9110
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174521488
—
RI
Enumeration date
10/06/2021
Last updated
10/06/2021
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