Healthcare Provider Details

I. General information

NPI: 1386561702
Provider Name (Legal Business Name): ALEXCIA TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 300
COLUMBIA MD
21045-3296
US

IV. Provider business mailing address

1717 MILL BRANCH DR
LAUREL MD
20708-3414
US

V. Phone/Fax

Practice location:
  • Phone: 410-885-6223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: