Doctor Name: | TRACY BRENTON |
NPI Number: | 1033462627 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | LC4717 |
Business Practice Address: | 14450 Hanover Pike Reisterstown, MD - 21136 |
Business Phone Number: | 4105699497 |
Business Fax Number: | 4105690094 |
Mailing Address: | 2227 Old Emmorton Rd, Suite 119 BEL AIR |
State: | MD |
Postal Code: | 210156187 |
Phone Number: | 4105609497 |
Fax Number: | 4105690094 |
NPI Enumeration Date: | 10/19/2012 |
NPI Last Update Date: | 10/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC4717 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |