Provider Demographics
NPI:1275620387
Name:TUCKER, DOROTHY DURHAM (PHD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:DURHAM
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 30TH AVE S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2511
Mailing Address - Country:US
Mailing Address - Phone:615-478-9967
Mailing Address - Fax:
Practice Address - Street 1:110 30TH AVE S
Practice Address - Street 2:SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2511
Practice Address - Country:US
Practice Address - Phone:615-478-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical