Provider Demographics
NPI:1447005657
Name:SOLTYCKI, TRACI MARIE (LPC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:MARIE
Last Name:SOLTYCKI
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 1:1101 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3328
Mailing Address - Country:US
Mailing Address - Phone:610-405-8313
Mailing Address - Fax:
Practice Address - Street 1:306 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2450
Practice Address - Country:US
Practice Address - Phone:610-968-1236
Practice Address - Fax:610-968-1236
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional