Healthcare Provider Details

I. General information

NPI: 1922713783
Provider Name (Legal Business Name): TIFFANY YVONNE TUCKER CPRS,CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12115 SHERATON LN
CINCINNATI OH
45246-1613
US

IV. Provider business mailing address

985 DEBBE LN APT 1
CINCINNATI OH
45229-1629
US

V. Phone/Fax

Practice location:
  • Phone: 513-540-4750
  • Fax:
Mailing address:
  • Phone: 513-514-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.194338
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.003835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: