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General NPI Number Information
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NPI Number | 1407718562
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Entity Type | Individual
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Provider Name | CASEY CAESAR TUCKER LGPC
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Gender | Female
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 4329 NORTHVIEW DR
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City | BOWIE
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State | MD
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Zip | 20716-2601
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Country | US
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Telephone | 301-684-4606
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Fax | 240-331-0545
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Provider Business Mailing Address
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Address Line | 7240 BRINLEY WAY
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City | HANOVER
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State | MD
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Zip | 21076-2112
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Country | US
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Telephone | 803-431-9837
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGP14663
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License Number State | MD
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