Provider Information for 1649963695
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TRACY CRUSE LCMHCA
Sex: Female
NPI: 1649963695
Last Updated: 2023-11-13
Certification Date: 2023-11-13
Certification Date: 2023-11-13
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1649963695 | ||||||||
| Enumeration Date | 2023-05-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 696 N SPENCE AVE STE C GOLDSBORO, NC 27534-4354 United States Phone: 919-581-7072 | Fax:919-288-1879 | ||||||||
| Primary Practice Address | 696 N SPENCE AVE STE C GOLDSBORO, NC 27534-4354 United States Phone: 919-581-7072 | Fax:919-288-1879 | ||||||||
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