Provider Demographics
NPI:1528464815
Name:TUCKER, BERNICE
Entity type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:
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 1:2200 GARRISON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2649
Mailing Address - Country:US
Mailing Address - Phone:410-878-0357
Mailing Address - Fax:443-835-1469
Practice Address - Street 1:2200 GARRISON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2649
Practice Address - Country:US
Practice Address - Phone:410-878-0357
Practice Address - Fax:443-835-1469
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor