Individual
MISS TICOLA SHONDRODA TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 MAIN ST STE 300, COLUMBIA, SC 29201-3203
(877) 418-2978
(866) 500-2186
Mailing address
1301 MAIN ST STE 300, COLUMBIA, SC 29201-3203
(877) 418-2798
(866) 500-2186
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
SC
Other
Enumeration date
12/16/2022
Last updated
12/16/2022
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