| Doctor Name: | CAROLYN ROSE TUCKER |
| NPI Number: | 1053688143 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC007670 |
| Business Practice Address: | 1009 Milstead Ave Ne Ste 210 Conyers, GA - 300124510 |
| Business Phone Number: | 7707890847 |
| Business Fax Number: | |
| Mailing Address: | 2424 Santa Barbra Ct Se, CONYERS |
| State: | GA |
| Postal Code: | 300132006 |
| Phone Number: | 7707890847 |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2011 |
| NPI Last Update Date: | 01/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC007670 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |