Provider Demographics
NPI:1912680570
Name:TUCKER, LATROYA MARTIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LATROYA
Middle Name:MARTIN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LATROYA
Other - Middle Name:SHAMINE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:816 INDEPENDENCE BOULEVARD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:804-854-5613
Mailing Address - Fax:
Practice Address - Street 1:816 INDEPENDENCE BOULEVARD
Practice Address - Street 2:SUITE 1B
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-363-6777
Practice Address - Fax:757-363-6778
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040144331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical