Provider Demographics
NPI:1669239521
Name:TUCKER, KENDALE D
Entity type:Individual
Prefix:
First Name:KENDALE
Middle Name:D
Last Name:TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26015 REEDY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-7737
Mailing Address - Country:US
Mailing Address - Phone:804-896-4951
Mailing Address - Fax:
Practice Address - Street 1:26015 REEDY RD
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-7737
Practice Address - Country:US
Practice Address - Phone:804-896-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker