Provider Demographics
NPI:1578186433
Name:TUCKER, CHRISTINA LAFFERTY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LAFFERTY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 KINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37892-2233
Mailing Address - Country:US
Mailing Address - Phone:606-521-5865
Mailing Address - Fax:
Practice Address - Street 1:2221 KINGTOWN RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:TN
Practice Address - Zip Code:37892-2233
Practice Address - Country:US
Practice Address - Phone:606-521-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLBA0000000556103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst