Provider Demographics
NPI:1326621756
Name:TUCKER, ROBERT D (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:D
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ROBERT D TUCKER LCSW
Mailing Address - Street 1:120 MANDY DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2117
Mailing Address - Country:US
Mailing Address - Phone:706-352-9482
Mailing Address - Fax:
Practice Address - Street 1:120 MANDY DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2117
Practice Address - Country:US
Practice Address - Phone:706-352-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical