Doctor Name: | MRS. SONYA NESMITH TUCKER |
NPI Number: | 1386706935 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 002771 |
Business Practice Address: | 105 Greencastle Rd Suite B Tyrone, GA - 302902937 |
Business Phone Number: | 7704861011 |
Business Fax Number: | 7704861067 |
Mailing Address: | 129 Interlochen Dr, PEACHTREE CITY |
State: | GA |
Postal Code: | 302693356 |
Phone Number: | 7704861811 |
Fax Number: | |
NPI Enumeration Date: | 12/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 002771 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |