Provider Demographics
NPI:1730432626
Name:TUCKER, NATALIE (BCBA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6185 LES DORSON LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3227
Mailing Address - Country:US
Mailing Address - Phone:602-558-0971
Mailing Address - Fax:
Practice Address - Street 1:6185 LES DORSON LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3227
Practice Address - Country:US
Practice Address - Phone:602-558-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst