Provider Demographics
NPI:1902988041
Name:OAKES, MARILYN TUCK (CRC LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:TUCK
Last Name:OAKES
Suffix:
Gender:F
Credentials:CRC LCPC
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:FRANCIS
Other - Last Name:TUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRC LPC
Mailing Address - Street 1:5182 PINELAND PL SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2365
Mailing Address - Country:US
Mailing Address - Phone:404-627-2004
Mailing Address - Fax:404-506-9067
Practice Address - Street 1:2130 KINGSTON CT SE STE D
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8952
Practice Address - Country:US
Practice Address - Phone:404-627-2004
Practice Address - Fax:404-506-9067
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3698101YP2500X
IL180.005969101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional