Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 104100000X | Social Worker | 6801103784 | MI |
N | 1041C0700X | Clinical Social Worker | 6801103784 | MI |
NPI | 1003278631 |
---|---|
Provider Name | Olivia Kathleen Tucker |
First Address | Flint, MI 48503-1552 |
Second Address | Flint, MI 48503-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 11/02/2020 |