Provider Demographics
NPI:1043055536
Name:KNOWS, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:KNOWS
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 1:9006 HOME GUARD DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2121
Mailing Address - Country:US
Mailing Address - Phone:703-414-9446
Mailing Address - Fax:
Practice Address - Street 1:9006 HOME GUARD DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2121
Practice Address - Country:US
Practice Address - Phone:703-414-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health