Provider Demographics
NPI:1386783355
Name:TUCKER, SANDRA H (LPC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:H
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:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:FANCY GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24328-0203
Mailing Address - Country:US
Mailing Address - Phone:276-728-9860
Mailing Address - Fax:
Practice Address - Street 1:351 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3850
Practice Address - Country:US
Practice Address - Phone:336-786-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health