| NPI | 1902090780 |
|---|---|
| Former Name | AMANDA LEIGHT TUCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 3203) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2018-04-25 |