Provider Demographics
NPI:1841180585
Name:TUCKER, GAIL ROBERTA (LGPC)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ROBERTA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:R
Other - Last Name:HARLESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16900 SCIENCE DR STE 208-210
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4401
Mailing Address - Country:US
Mailing Address - Phone:240-508-3900
Mailing Address - Fax:
Practice Address - Street 1:16900 SCIENCE DR STE 208-210
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4401
Practice Address - Country:US
Practice Address - Phone:240-508-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health