Provider Demographics
NPI:1578828943
Name:TUCKER, BERNICE BELINDA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:BELINDA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 BARNWELL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3566
Mailing Address - Country:US
Mailing Address - Phone:803-451-1104
Mailing Address - Fax:803-799-9458
Practice Address - Street 1:1411 BARNWELL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3566
Practice Address - Country:US
Practice Address - Phone:803-451-1104
Practice Address - Fax:803-799-9458
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5409101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional