Basic Information
| Provider Information | |||||||||
| NPI: | 1306023080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAYWICK | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | BOWMAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | L.M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 VANCE ST E | ||||||||
| Address2: | PO BOX 1426 | ||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278934034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522912344 | ||||||||
| FaxNumber: | 2522911436 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 VANCE ST E | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278934034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522912344 | ||||||||
| FaxNumber: | 2522911436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1215 | NC | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.