Provider Demographics
NPI:1629211248
Name:TUCKER, ANGELA DANIELS (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DANIELS
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 HARBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4105
Mailing Address - Country:US
Mailing Address - Phone:919-803-4317
Mailing Address - Fax:
Practice Address - Street 1:809 SPRING FOREST RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9700
Practice Address - Country:US
Practice Address - Phone:919-649-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional