Individual
HEIDI TRACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CAS, LGPC, NCSP
Contact information
Practice address
58 MILLHAVEN CT, EDGEWATER, MD 21037-1825
(443) 808-1531
Mailing address
4450 MITCHELLVILLE RD # 1224, BOWIE, MD 20716-3112
(443) 808-1531
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP12742
MD
103TS0200X
School Psychologist
CER81316Q8M6T9
MD
Other
Enumeration date
06/19/2023
Last updated
10/29/2024
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