MEDICARE: SARA L TUKE MA, LPC, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701004741	VA
2	101YM0800X	Mental Health Counselor	LC3318	MD

General Provider Information

NPI Number	:	1336461359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA L TUKE MA, LPC, LCPC

Provider Business Mailing Address
First Line	:	4677 34TH ST S
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-1701
Country	:	US
Telephone Number	:	240-997-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 CHAIN BRIDGE RD STE 300
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-5727
Country	:	US
Telephone Number	:	703-745-2014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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