| Doctor Name: | TRACEY FATZINGER |
| NPI Number: | 1083874051 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 0810003548 |
| Business Practice Address: | 11311 Business Center Dr Ste C North Chesterfield, VA - 232363199 |
| Business Phone Number: | 8043786141 |
| Business Fax Number: | |
| Mailing Address: | 4919 Park Meadows Ln, GLEN ALLEN |
| State: | VA |
| Postal Code: | 230592518 |
| Phone Number: | 8043148780 |
| Fax Number: | |
| NPI Enumeration Date: | 06/13/2008 |
| NPI Last Update Date: | 01/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810003548 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |