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General NPI Number Information
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NPI Number | 1902486863
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Entity Type | Individual
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Provider Name | APOLLONIA LATRICE TUCKER-LEWIS
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Gender | Female
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 4651 SALISBURY RD. STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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Country | US
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Telephone | 321-278-6791
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Fax |
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Provider Business Mailing Address
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Address Line | 4415C CONSTITUTION LN # 208
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City | MARIANNA
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State | FL
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Zip | 32448-4472
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Country | US
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Telephone | 321-278-6791
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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 | MH19037
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License Number State | FL
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