Provider Demographics
NPI:1548356041
Name:WINGOLD, TRACEY (LCSW)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:WINGOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-1831
Mailing Address - Country:US
Mailing Address - Phone:804-370-0872
Mailing Address - Fax:804-316-9694
Practice Address - Street 1:10 S CRENSHAW AVE STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2732
Practice Address - Country:US
Practice Address - Phone:804-370-0872
Practice Address - Fax:804-316-9694
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004645182Medicaid