Tracy Russell, MSW, LCSW-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P010744 Issued in NC

Practice address

9205 Baileywick Rd
Raleigh, NC 27615-1977

Phone

(919) 845-5400

NPI assigned

Oct 12, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Loving and Living Center

  dba Awakenings Couples Counseling

  • Marriage & Family Therapist
  • Raleigh, NC
  • NPI 1437603198
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548374400000",
    "number": "1609326826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5411 NEWHALL RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277132523",
            "telephone_number": "336-392-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9205 BAILEYWICK RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276151977",
            "telephone_number": "919-845-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5411 Newhall Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277132523",
            "country_code": "US",
            "telephone_number": "336-392-2639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TRACY",
        "credential": "MSW, LCSW-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-12",
        "last_updated": "2019-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "P010744",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P010744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Bivins Russell, MD
• Sean Russell
• Stuart Dean Russell, M.D.
• Teyona Alyse' Russell
• Toniyah Russell
• Justin Russo, D.D.S.
• Mary Beth Russo, MS, OTR/L
• Graciela Aires Rust, LCMHC, CRC, IWLC
• Oxana Rusu
• Thomas Caleb Rutan, CNS

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.