Provider Demographics
NPI:1447470869
Name:LANIER, TRACIE DENISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:DENISE
Last Name:LANIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 S EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2305
Mailing Address - Country:US
Mailing Address - Phone:773-480-1407
Mailing Address - Fax:773-468-1953
Practice Address - Street 1:10615 S EMERALD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2305
Practice Address - Country:US
Practice Address - Phone:773-480-1407
Practice Address - Fax:773-468-1953
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical