Provider Demographics
NPI:1457170714
Name:TUCKER, JESSICA (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
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 1:5935 HEARDS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COVESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22931-1636
Mailing Address - Country:US
Mailing Address - Phone:434-282-6186
Mailing Address - Fax:
Practice Address - Street 1:500 OLD LYNCHBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6500
Practice Address - Country:US
Practice Address - Phone:434-972-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health