Provider Demographics
NPI:1073399176
Name:RUCKER, TOMASINA (LCSW)
Entity Type:Individual
Prefix:
First Name:TOMASINA
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1255
Mailing Address - Country:US
Mailing Address - Phone:703-231-2249
Mailing Address - Fax:
Practice Address - Street 1:87 HIDDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1255
Practice Address - Country:US
Practice Address - Phone:703-231-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040157231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical