Provider Demographics
NPI:1295370245
Name:TUCKER, WILLIAM W (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N LYNNHAVEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7523
Mailing Address - Country:US
Mailing Address - Phone:757-264-9957
Mailing Address - Fax:757-963-0444
Practice Address - Street 1:101 N LYNNHAVEN RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-264-9957
Practice Address - Fax:757-963-0444
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional