Provider Demographics
NPI:1134591548
Name:SPIKE, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SPIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMELLIA LN APT 222
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4950
Mailing Address - Country:US
Mailing Address - Phone:678-979-7710
Mailing Address - Fax:678-922-7756
Practice Address - Street 1:100 CAMELLIA LN APT 222
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4950
Practice Address - Country:US
Practice Address - Phone:678-979-7710
Practice Address - Fax:678-922-7756
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker