Provider Demographics
NPI:1215593579
Name:TUCKER, ANDREA LYN (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24445 NORTHWESTERN HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2437
Mailing Address - Country:US
Mailing Address - Phone:586-416-2300
Mailing Address - Fax:586-416-2311
Practice Address - Street 1:234 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2965
Practice Address - Country:US
Practice Address - Phone:734-240-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0580017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health