Provider Demographics
NPI:1831671452
Name:STUCKE, ADAM (MS LCGC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:STUCKE
Suffix:
Gender:M
Credentials:MS LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD STE 500
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1928
Mailing Address - Country:US
Mailing Address - Phone:804-297-3055
Mailing Address - Fax:
Practice Address - Street 1:5875 BREMO RD STE 500
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1928
Practice Address - Country:US
Practice Address - Phone:804-297-3055
Practice Address - Fax:434-245-2015
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0139000289170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS