Provider Demographics
NPI:1083224299
Name:TUCKER, RAQUEL-MONET (RBT)
Entity Type:Individual
Prefix:
First Name:RAQUEL-MONET
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 OGEECHEE ROAD
Mailing Address - Street 2:SUITE 200 - 251
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-9515
Mailing Address - Country:US
Mailing Address - Phone:912-434-4343
Mailing Address - Fax:912-452-9600
Practice Address - Street 1:5710 OGEECHEE ROAD
Practice Address - Street 2:SUITE 200 - 251
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9515
Practice Address - Country:US
Practice Address - Phone:912-434-4343
Practice Address - Fax:912-452-9600
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-07-3468106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-07-3468OtherRBT CERTIFICATION - RELIAS LEARNING