Provider Demographics
NPI:1831470038
Name:TUCKER, ANTHONY (CAS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3906
Mailing Address - Country:US
Mailing Address - Phone:619-579-8373
Mailing Address - Fax:619-579-5188
Practice Address - Street 1:234 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3906
Practice Address - Country:US
Practice Address - Phone:619-579-8373
Practice Address - Fax:619-579-8155
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-886446101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)