Individual
DERRICK LEMOND TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO61083856
Contact information
Practice address
201 HIGHLAND DR, BUENA, WA 98921-0139
(509) 865-6705
Mailing address
120 S 3RD ST, YAKIMA, WA 98901-2875
(509) 865-6705
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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