Healthcare Provider Details

I. General information

NPI: 1255480554
Provider Name (Legal Business Name): LAURA L TUCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 MERRIMAC TRL
WILLIAMSBURG VA
23185-5624
US

IV. Provider business mailing address

3972 LONGHILL STATION RD
WILLIAMSBURG VA
23188-7368
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-3200
  • Fax:
Mailing address:
  • Phone: 757-345-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0904002567
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: