Individual
MS. DALE ELIZABETH TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCO 893
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1X84
BCBS PPO
MD
01
—
223697
COMPSYCH PROVIDER
MD
01
—
7183355
AETNA PROVIDER
MD
01
—
G5120001
BCBS DC PROVIDER
MD
Enumeration date
02/07/2007
Last updated
07/08/2007
Update your record
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