Tracey Lynette Wilson

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

3613 Chain Bridge Rd Ste D
Fairfax, VA 22030-3238

Phone

(703) 397-8163

NPI assigned

Jan 6, 2022

Last updated

Jan 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  DC

  Medicare reassignment NPD
• The Heart Leaf Center

  • Clinical Social Worker
  • Fairfax, VA
  • NPI 1659044014
  NPD (past)

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1952062317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3611 CHAIN BRIDGE RD STE C",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303246",
            "telephone_number": "703-397-8163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 CHAIN BRIDGE RD STE D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303238",
            "telephone_number": "703-397-8163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TRACEY",
        "middle_name": "LYNETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "tracy@heartleafcenter.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "3613 Chain Bridge Rd Ste D",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220303238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mazzie Wilson
• Melodi Lynette Wilson, M.D.
• Paulina G Wilson, M.D.
• Samantha Wilson
• Sherri Wilson, RN
• Othon Wiltz, M.D.
• Natalie Lauren Wilver, PHD
• Sjor'Monique La'Quinta Winbush
• Susan Windley, OTA
• Arthur Ackerman Winer, M.D.

• Counselor in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.