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General NPI Number Information
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NPI Number | 1578218533
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Entity Type | Organization
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Legal Business Name | KELSEE TUCKER
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 701 E 2ND AVE SUITE A
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City | ROME
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State | GA
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Zip | 30161
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Country | US
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Telephone | 706-766-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 222 LAURENS RD
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City | ROCKMART
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State | GA
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Zip | 30153-3107
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Country | US
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Telephone | 706-766-0137
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | KELSEE LYNN TUCKER
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Credential | LCSW
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Telephone | 706-766-0137
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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 |
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License Number State |
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