Active NPI
Tracey B Irvine, LPC
- Professional Counselor
- Lenoir, NC
National Provider Identifier
1255797940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 12010
- Practice address
- 2415 Morganton Blvd SW
Lenoir, NC 28645-9691 - Phone
- (828) 394-5566
- Fax
- (828) 394-5418
- NPI assigned
- Jan 11, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 12010 | NC | Primary |
Addresses
Primary practice location
2415 Morganton Blvd SW
Lenoir, NC 28645-9691
Mailing address
2415 Morganton Blvd SW
Lenoir, NC 28645-9691
Phone (828) 394-5566
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12010 | Other | NC | LICENSURE |
Other names 1
- Tracey B Clark
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539648000000",
"number": "1255797940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 MORGANTON BLVD SW",
"city": "LENOIR",
"state": "NC",
"postal_code": "286459691",
"telephone_number": "828-394-5566",
"fax_number": "828-394-5418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 MORGANTON BLVD SW",
"city": "LENOIR",
"state": "NC",
"postal_code": "286459691",
"telephone_number": "828-394-5566",
"fax_number": "828-394-5418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRVINE",
"first_name": "TRACEY",
"middle_name": "B",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-11",
"last_updated": "2018-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "12010",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSURE",
"identifier": "12010",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TRACEY",
"last_name": "CLARK",
"middle_name": "B",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lenoir, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.