| NPI | 1437626454 |
|---|---|
| Doing Business As | TUCKERVILLE.LLC |
| Doing Business As | FARTIMA TUCKER |
| Former Legal Business Name | TUCKERVILLE LLC |
| Entity Type | Organization |
| Authorized Contact | FARTIMA TUCKER Clinical Psycho Therapist 313-312-5706 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2023-05-12 |