Provider Demographics
NPI:1952350357
Name:TUCKER, CHRISTINE MCDOWELL (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MCDOWELL
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E SOUTH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5215
Mailing Address - Country:US
Mailing Address - Phone:434-971-4747
Mailing Address - Fax:434-293-4690
Practice Address - Street 1:100 E SOUTH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5215
Practice Address - Country:US
Practice Address - Phone:434-971-4747
Practice Address - Fax:434-293-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7704844Medicaid
082060OtherSENTARA MENTAL HEALTH
173900OtherCOMPSYCH
2179122OtherFIRST HEALTH
061336OtherANTHEM BLUE CROSS
7704844OtherVIRGINIA PREMIER
254572000OtherMAGELLAN
344334OtherMHN
036808OtherVALUE OPTIONS
541758783OtherVIRGINIA HEALTH NETWORK
541758783OtherVIRGINIA HEALTH NETWORK
344334OtherMHN