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General NPI Number Information
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NPI Number | 1265865760
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Entity Type | Individual
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Provider Name | JAMES ROBERT TUCKER LCAS
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Gender | Male
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 3011 S MEMORIAL DR STE 12
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City | GREENVILLE
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State | NC
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Zip | 27834-6238
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Country | US
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Telephone | 252-353-5433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1195
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City | BETHEL
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State | NC
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Zip | 27812-1195
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Country | US
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Telephone | 252-864-9334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3490
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3490A
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License Number State | NC
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