Provider Demographics
NPI:1275848053
Name:TUCKER, DONALD A (LPC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
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 1:1803 DOVER POINTE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4166
Mailing Address - Country:US
Mailing Address - Phone:804-741-2787
Mailing Address - Fax:
Practice Address - Street 1:1803 DOVER POINTE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4166
Practice Address - Country:US
Practice Address - Phone:804-741-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000807101YP2500X
VAPENDING RENEWAL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool