Healthcare Provider Details

I. General information

NPI: 1447795802
Provider Name (Legal Business Name): LATICIA D. TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 5TH ST
RICHMOND VA
23219-3825
US

IV. Provider business mailing address

26015 REEDY RD
NORTH DINWIDDIE VA
23803-7737
US

V. Phone/Fax

Practice location:
  • Phone: 804-819-4000
  • Fax:
Mailing address:
  • Phone: 804-892-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: