Provider Demographics
NPI:1083874051
Name:FATZINGER, TRACEY (PHD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:FATZINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 STONEBRIDGE PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-6972
Mailing Address - Country:US
Mailing Address - Phone:804-378-6141
Mailing Address - Fax:804-378-6183
Practice Address - Street 1:221 STONEBRIDGE PLAZA AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-6972
Practice Address - Country:US
Practice Address - Phone:804-378-6141
Practice Address - Fax:804-378-6183
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical