Provider Demographics
NPI:1770003311
Name:INCEPTUS PSYCHOLOGICAL & CONSULTING SERVICES
Entity Type:Organization
Organization Name:INCEPTUS PSYCHOLOGICAL & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:MALLARD
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-786-5486
Mailing Address - Street 1:709 PENDLETON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1820
Mailing Address - Country:US
Mailing Address - Phone:703-786-5486
Mailing Address - Fax:703-842-8746
Practice Address - Street 1:709 PENDLETON ST STE 202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1820
Practice Address - Country:US
Practice Address - Phone:703-786-5486
Practice Address - Fax:703-842-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007049101YM0800X
VA0810004954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty