Provider Demographics
NPI:1467291815
Name:TUCKER, ATCHAFALA M (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:ATCHAFALA
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:MS
Other - First Name:ATCHAFALA
Other - Middle Name:
Other - Last Name:BENJAMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2825 DEER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-3755
Mailing Address - Country:US
Mailing Address - Phone:302-383-7255
Mailing Address - Fax:
Practice Address - Street 1:2825 DEER CREEK CT
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-3755
Practice Address - Country:US
Practice Address - Phone:302-383-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional