Provider Demographics
NPI:1760412183
Name:WILLIAMS, LANA TUCKER (ACSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:TUCKER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 ACADEMY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3205
Mailing Address - Country:US
Mailing Address - Phone:757-483-6404
Mailing Address - Fax:757-483-0737
Practice Address - Street 1:3300 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3205
Practice Address - Country:US
Practice Address - Phone:757-483-6404
Practice Address - Fax:757-483-0737
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA452681OtherMAMSI
VA753149110OtherCOMMERCIAL
VA010063523Medicaid
VA044796OtherVALUE OPTIONS
VA116162OtherVA. BL BS
VA234673OtherCOM PSYCH
VA7531491OtherCHAMPUS/TRICARE
VA089195OtherOPTIMA MH
VA7882412OtherAETNA
VA131949OtherMHN
VA060612000OtherMAGELLAN
VA753149110OtherCOMMERCIAL
VA452681OtherMAMSI