Provider Demographics
NPI:1124662978
Name:TUCKER, PEGGIE K (LICSW)
Entity type:Individual
Prefix:MS
First Name:PEGGIE
Middle Name:K
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 LIZZIE LN SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9358
Mailing Address - Country:US
Mailing Address - Phone:256-603-5166
Mailing Address - Fax:
Practice Address - Street 1:814 PALMER RD STE B4
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3185
Practice Address - Country:US
Practice Address - Phone:256-325-0467
Practice Address - Fax:256-325-0469
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0260-0931C101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor