Active NPI
Tracy Rebecca Ray Perez, MS, LCMHC
- Professional Counselor
- Jacksonville, NC
National Provider Identifier
1154911428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 16109
- Practice address
- 200 Doctors Dr Ste M
Jacksonville, NC 28546-6308 - Phone
- (252) 999-9882
- NPI assigned
- Jan 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 16109 | NC | |
| Professional Counselor | 101YP2500X | 16109 | NC | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16109 | NC |
Addresses
Primary practice location
200 Doctors Dr Ste M
Jacksonville, NC 28546-6308
Mailing address
200 Doctors Dr Ste M
Jacksonville, NC 28546-6308
Phone (252) 999-9882
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16109 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1154911428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 DOCTORS DR STE M",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466308",
"telephone_number": "252-999-9882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 DOCTORS DR STE M",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466308",
"telephone_number": "252-999-9882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "TRACY",
"middle_name": "REBECCA RAY",
"name_prefix": "Ms.",
"credential": "MS, LCMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-21",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "16109",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "16109",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "16109",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.