Provider Demographics
NPI:1457899049
Name:TUCKER, ANTHONY C. (A020740915)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY C.
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:A020740915
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1815
Mailing Address - Country:US
Mailing Address - Phone:323-812-9892
Mailing Address - Fax:
Practice Address - Street 1:937 W ELM ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1815
Practice Address - Country:US
Practice Address - Phone:323-812-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)