Provider Demographics
NPI:1326200064
Name:TUCKER, STEPHANIE SWAIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SWAIN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FARLEY BRANCH DR
Mailing Address - Street 2:P.O. BOX 4614
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-0614
Mailing Address - Country:US
Mailing Address - Phone:434-515-0503
Mailing Address - Fax:
Practice Address - Street 1:121 FARLEY BRANCH DR
Practice Address - Street 2:4614
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-0614
Practice Address - Country:US
Practice Address - Phone:434-515-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical