Provider Demographics
NPI:1457681827
Name:WHITE, TRACIE LANELL (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:LANELL
Last Name:WHITE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11861 W VOMAC RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1048
Mailing Address - Country:US
Mailing Address - Phone:424-234-8069
Mailing Address - Fax:
Practice Address - Street 1:3093 BROADWAY UNIT PH76
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5965
Practice Address - Country:US
Practice Address - Phone:510-545-6463
Practice Address - Fax:510-217-3588
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program