Provider Demographics
NPI:1700111341
Name:RUCKER, AMAYA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMAYA
Middle Name:A
Last Name:RUCKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 CANON BLVD
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2570
Mailing Address - Country:US
Mailing Address - Phone:757-223-1909
Mailing Address - Fax:757-240-2670
Practice Address - Street 1:11835 CANON BLVD
Practice Address - Street 2:SUITE B-102
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2570
Practice Address - Country:US
Practice Address - Phone:757-223-1909
Practice Address - Fax:757-240-2670
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004168103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical