Provider Demographics
NPI:1639870496
Name:TUCKER, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITMIRE
Mailing Address - State:SC
Mailing Address - Zip Code:29178-1504
Mailing Address - Country:US
Mailing Address - Phone:803-768-6794
Mailing Address - Fax:
Practice Address - Street 1:97 COLE AVE
Practice Address - Street 2:
Practice Address - City:WHITMIRE
Practice Address - State:SC
Practice Address - Zip Code:29178-1504
Practice Address - Country:US
Practice Address - Phone:803-768-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician