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Organization
TUCKERVILLE
Active
Organization
TUCKERVILLE
Active
Parent organization
-
Other names
TUCKERVILLE.LLC, FARTIMA TUCKER, TUCKERVILLE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
-
Authorized official
MRS. FARTIMA TUCKER PH.D, LMSW, CIMHP (CLINICAL PSYCHOTHERAPIST)
(313) 312-5706
Entity
Organization
Contact information
Practice address
35230 E MICHIGAN AVE, WAYNE, MI 48184-3698
(313) 312-5706
(734) 345-4104
Mailing address
PO BOX 125, BELLEVILLE, MI 48112-0125
(313) 303-7423
(734) 345-4104
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8025368
—
MI
Enumeration date
10/29/2018
Last updated
09/13/2025
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