Doctor Name: | MRS. TARA LUECKING |
NPI Number: | 1275907321 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | LC6670 |
Business Practice Address: | 1110 Benfield Blvd Suite J Millersville, MD - 211082639 |
Business Phone Number: | 4104906828 |
Business Fax Number: | |
Mailing Address: | 104 Laird Benton Rd, STEVENSVILLE |
State: | MD |
Postal Code: | 216663224 |
Phone Number: | 4104906828 |
Fax Number: | |
NPI Enumeration Date: | 11/30/2015 |
NPI Last Update Date: | 11/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LC6670 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |