Provider Demographics
NPI:1043039472
Name:HABACIVCH, TRACY Y (LPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:Y
Last Name:HABACIVCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 IMPALA DR
Mailing Address - Street 2:
Mailing Address - City:RONKS
Mailing Address - State:PA
Mailing Address - Zip Code:17572-9626
Mailing Address - Country:US
Mailing Address - Phone:717-572-2331
Mailing Address - Fax:
Practice Address - Street 1:2493 IMPALA DR
Practice Address - Street 2:
Practice Address - City:RONKS
Practice Address - State:PA
Practice Address - Zip Code:17572-9626
Practice Address - Country:US
Practice Address - Phone:717-572-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor