Provider Demographics
NPI:1548842321
Name:EASTON, TRACEY (LMSW)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:EASTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7012
Mailing Address - Country:US
Mailing Address - Phone:718-838-0394
Mailing Address - Fax:
Practice Address - Street 1:428 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7012
Practice Address - Country:US
Practice Address - Phone:718-838-0394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1439104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker