Provider Demographics
NPI:1144980228
Name:TUCKER, CHERYL DIANE
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 FALCONETT CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6012
Mailing Address - Country:US
Mailing Address - Phone:301-704-4995
Mailing Address - Fax:
Practice Address - Street 1:1207 FALCONETT CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-6012
Practice Address - Country:US
Practice Address - Phone:301-704-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health