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General NPI Number Information
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NPI Number | 1902988041
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Entity Type | Individual
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Provider Name | MARILYN TUCK OAKES CRC LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 2130 KINGSTON CT SE STE D
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City | MARIETTA
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State | GA
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Zip | 30067-8952
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Country | US
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Telephone | 404-627-2004
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Fax | 404-506-9067
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Provider Business Mailing Address
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Address Line | 5182 PINELAND PL SW
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City | MABLETON
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State | GA
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Zip | 30126-2365
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Country | US
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Telephone | 404-627-2004
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Fax | 404-506-9067
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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 | 3698
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.005969
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License Number State | IL
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