Individual
TRACY MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
1149 SULLIVAN ST STE B, ELMIRA, NY 14901-1670
(607) 733-7661
(607) 733-7675
Mailing address
1149 SULLIVAN ST STE B, ELMIRA, NY 14901-1670
(607) 733-7661
(607) 733-7675
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NY
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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