Provider Demographics
NPI:1144693904
Name:TRACY REID-BARROW LCSW LLC
Entity type:Organization
Organization Name:TRACY REID-BARROW LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:REID-BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-421-2302
Mailing Address - Street 1:730 PORTER LN
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-2288
Mailing Address - Country:US
Mailing Address - Phone:706-421-2302
Mailing Address - Fax:706-925-5692
Practice Address - Street 1:730 PORTER LN
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-2288
Practice Address - Country:US
Practice Address - Phone:706-421-2302
Practice Address - Fax:706-925-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0056151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty