Provider Demographics
NPI:1023310844
Name:TUCKER, JON DRIVER (LPC)
Entity type:Individual
Prefix:MRS
First Name:JON
Middle Name:DRIVER
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JON D.
Other - Middle Name:(SHON)
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:273 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4027
Mailing Address - Country:US
Mailing Address - Phone:540-434-8450
Mailing Address - Fax:540-433-3805
Practice Address - Street 1:273 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4027
Practice Address - Country:US
Practice Address - Phone:540-434-8450
Practice Address - Fax:540-433-3805
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000937101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor