Provider Demographics
NPI:1366958183
Name:AIM 4 PERFECTION
Entity type:Organization
Organization Name:AIM 4 PERFECTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-583-0433
Mailing Address - Street 1:124 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930-1802
Mailing Address - Country:US
Mailing Address - Phone:434-538-0433
Mailing Address - Fax:
Practice Address - Street 1:124 E CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930-1802
Practice Address - Country:US
Practice Address - Phone:434-538-0433
Practice Address - Fax:434-538-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health