| NPI | 1073157962 |
|---|---|
| Former Name | ALIX RENEE TUCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO csw.09926837) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 22844) |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2020-10-19 |