Klucina, Tracy Lou

Klucina, Tracy Lou is an individual health care provider with primary practice located at 3430 Wheatley Ave , Charlotte NC 28205-7654. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Klucina, Tracy Lou can be contacted via phone (704) 591-2026.

Contact Information

Primary practice address
3430 Wheatley Ave Charlotte NC 28205-7654
Phone: (704) 591-2026
Fax: (704) 336-6559
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 944 North Carolina

Profile Details

NPI number 1184761520
LBN Legal business name Klucina, Tracy Lou
Credentials LCAS
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184761520 NPPES
North Carolina MEDICAID 6111873

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