Provider Demographics
NPI:1043632102
Name:TUCKER, MELEECIA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELEECIA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:MELEECIA
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:3636 UNIVERSITY BLVD S STE A9
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4209
Mailing Address - Country:US
Mailing Address - Phone:904-536-4415
Mailing Address - Fax:904-575-4162
Practice Address - Street 1:4417 BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4728
Practice Address - Country:US
Practice Address - Phone:904-551-4953
Practice Address - Fax:904-212-2366
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7573101YM0800X
FL2805101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty