Individual
LATICIA D. TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5663 S LABURNUM AVE, HENRICO, VA 23231-4418
(804) 737-3917
Mailing address
26015 REEDY RD, NORTH DINWIDDIE, VA 23803-7737
(804) 892-4146
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13941758
CAQH
—
Enumeration date
12/21/2016
Last updated
12/21/2016
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