Provider Demographics
NPI:1720222730
Name:TUCKER, CHRISTINA LEE (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LEE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:4647 CLYDE MORRIS BLVD UNIT 501
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3001
Mailing Address - Country:US
Mailing Address - Phone:386-767-3752
Mailing Address - Fax:
Practice Address - Street 1:4647 CLYDE MORRIS BLVD UNIT 501
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3001
Practice Address - Country:US
Practice Address - Phone:386-767-3752
Practice Address - Fax:386-767-4319
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-12857103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst