Healthcare Provider Details

I. General information

NPI: 1295370245
Provider Name (Legal Business Name): WILLIAM W TUCKER LPC, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N LYNNHAVEN RD STE 100
VIRGINIA BEACH VA
23452-7523
US

IV. Provider business mailing address

101 N LYNNHAVEN RD STE 100
VIRGINIA BEACH VA
23452-7523
US

V. Phone/Fax

Practice location:
  • Phone: 757-264-9957
  • Fax: 757-963-0444
Mailing address:
  • Phone: 757-264-9957
  • Fax: 757-963-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: