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General NPI Number Information
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NPI Number | 1528737020
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Entity Type | Individual
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Provider Name | COURTNEY E'CLAIR TUCKER
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 650 PONCE DE LEON AVE STE 300 #2139
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 678-379-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 650 PONCE DE LEON AVE STE 300 #2139
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW008527
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 122648
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW021134
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License Number State | PA
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