Provider Demographics
NPI:1902940877
Name:BECKER, TRACY LORRAINE (LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LORRAINE
Last Name:BECKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PROFESSIONAL PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5600
Mailing Address - Country:US
Mailing Address - Phone:704-664-1009
Mailing Address - Fax:704-664-1029
Practice Address - Street 1:134 PROFESSIONAL PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5600
Practice Address - Country:US
Practice Address - Phone:704-664-1009
Practice Address - Fax:704-664-1029
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103563Medicaid
NC144VCOtherBCBS