Provider Information for 1922330968
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Mrs. TRACEY ARLENE BOUBACAR MS,MSW,LCSW
Sex: Female
NPI: 1922330968
Last Updated: 2013-06-05
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1922330968 | ||||||||
| Enumeration Date | 2010-02-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 284 EXECUTIVE PARK DR SUITE100 CONCORD, NC 28025-1831 United States Phone: 704-939-1100 | Fax: | ||||||||
| Primary Practice Address | 405 NC HWY 65 REIDSVILLE, NC 27320-8882 United States Phone: 336-342-8316 | Fax:336-342-8352 | ||||||||
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