Provider Demographics
NPI:1932090636
Name:POWERS, TRACI BUNN
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:BUNN
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PIERCES CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8911
Mailing Address - Country:US
Mailing Address - Phone:757-404-7103
Mailing Address - Fax:757-369-1981
Practice Address - Street 1:11713 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2400
Practice Address - Country:US
Practice Address - Phone:757-503-2819
Practice Address - Fax:757-369-1981
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704018104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health