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General NPI Number Information
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NPI Number | 1336545029
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Entity Type | Individual
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Provider Name | ANDREA TUCK
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Gender | Female
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 24 GRANNY SMITH CT
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City | BALTIMORE
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State | MD
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Zip | 21220
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Country | US
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Telephone | 443-841-4238
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Fax | 410-918-1839
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Provider Business Mailing Address
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Address Line | 24 GRANNY SMITH CT
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City | BALTIMORE
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State | MD
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Zip | 21220-1749
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Country | US
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Telephone | 443-841-4238
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Fax | 410-918-1839
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC5920
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License Number State | MD
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