Provider Demographics
NPI:1831896422
Name:TUCKER, ATHANETTE (MS, LCMHC-A)
Entity type:Individual
Prefix:
First Name:ATHANETTE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 PIEDMONT PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8174
Mailing Address - Country:US
Mailing Address - Phone:336-855-4649
Mailing Address - Fax:
Practice Address - Street 1:4160 PIEDMONT PKWY STE 207
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8174
Practice Address - Country:US
Practice Address - Phone:336-855-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18572101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor