| Doctor Name: | DEANA LENETTE TUCKER |
| NPI Number: | 1003155094 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CAC-I |
| License Number: | |
| Business Practice Address: | 910 Cook Rd Orangeburg, SC - 291182124 |
| Business Phone Number: | 8035342328 |
| Business Fax Number: | 8035318419 |
| Mailing Address: | 910 Cook Rd, ORANGEBURG |
| State: | SC |
| Postal Code: | 291182124 |
| Phone Number: | 8035342328 |
| Fax Number: | 8035318419 |
| NPI Enumeration Date: | 02/11/2013 |
| NPI Last Update Date: | 02/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |