Provider Demographics
NPI:1114681731
Name:TUCKER, ACEY (LPC)
Entity Type:Individual
Prefix:MR
First Name:ACEY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E PARHAM RD
Mailing Address - Street 2:UNIT 28943
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1361
Mailing Address - Country:US
Mailing Address - Phone:804-943-6208
Mailing Address - Fax:
Practice Address - Street 1:3123 STONE ARBOR LN APT 1531
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7601
Practice Address - Country:US
Practice Address - Phone:804-943-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty