Individual
MR. JONATHAN TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMFT
Contact information
Practice address
15 LAGRANGE ST STE A, NEWNAN, GA 30263-2693
(678) 433-6634
Mailing address
113 KESWICK MANOR DR, TYRONE, GA 30290-1542
(336) 404-9590
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
101YS0200X
School Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
001169
GA
106H00000X
Marriage & Family Therapist
003450
CT
Other
Enumeration date
03/29/2007
Last updated
09/26/2024
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