Provider Demographics
NPI:1801637996
Name:TUCKER, TORIANNA JABRE
Entity type:Individual
Prefix:
First Name:TORIANNA
Middle Name:JABRE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TORIANNA
Other - Middle Name:
Other - Last Name:FANNIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 EBENEZER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-5006
Mailing Address - Country:US
Mailing Address - Phone:706-551-0362
Mailing Address - Fax:
Practice Address - Street 1:140 EBENEZER CHURCH RD
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822-5006
Practice Address - Country:US
Practice Address - Phone:706-551-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-345214106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician