Provider Demographics
NPI:1457072399
Name:TUCKER, NICHOLE VIOLET (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:VIOLET
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 CARTERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DE MOSSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41033-7502
Mailing Address - Country:US
Mailing Address - Phone:859-816-6734
Mailing Address - Fax:
Practice Address - Street 1:2128 CHAMBER CENTER DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE PARK
Practice Address - State:KY
Practice Address - Zip Code:41017-1669
Practice Address - Country:US
Practice Address - Phone:859-331-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2572131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical