Provider Demographics
NPI:1760499438
Name:TUCKER, HERMAN DAVIS JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:DAVIS
Last Name:TUCKER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DAVIS
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:421 W AIRLINE HWY
Mailing Address - Street 2:SUITE L
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3820
Mailing Address - Country:US
Mailing Address - Phone:985-651-7064
Mailing Address - Fax:985-651-7067
Practice Address - Street 1:421 W AIRLINE HWY
Practice Address - Street 2:SUITE L
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3820
Practice Address - Country:US
Practice Address - Phone:985-651-7064
Practice Address - Fax:985-651-7067
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical