Individual
TRACY CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
6037 N 11TH ST, PHILADELPHIA, PA 19141-3201
(215) 588-5071
Mailing address
6037 NORTH 11TH STREET, PHILADELPHIA, PA 19141
(215) 588-5071
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
PA
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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