Provider Demographics
NPI:1396334959
Name:DUNCAN, TRACIE JAINE
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:JAINE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TRACIE
Other - Middle Name:JAINE
Other - Last Name:SHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30101 HOOVER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-558-6868
Mailing Address - Fax:586-558-6893
Practice Address - Street 1:43800 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1136
Practice Address - Country:US
Practice Address - Phone:248-677-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022583101YM0800X
MI6401224972101YP2500X, 101Y00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant