Provider Demographics
NPI:1982712071
Name:TUCKER, ROBERT MACOM (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MACOM
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SANGERS LN
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-6712
Mailing Address - Country:US
Mailing Address - Phone:540-213-7315
Mailing Address - Fax:540-887-3273
Practice Address - Street 1:85 SANGERS LN
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-213-7315
Practice Address - Fax:540-887-3273
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000162106H00000X, 106H00000X
VA1887101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1021369OtherCIGNA
VA118590000OtherMAGELLAN
VA173867OtherCOMPSYCH
VA141896OtherTRICARE
VA283385OtherMAMSI
VAO82124OtherSOUTHERN HEALTH / SENTARA
VA056981OtherANTHEM
VA005402841Medicaid
VA142073OtherVALUE OPTIONS