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121 Farley Branch Drive Lynchburg VA 24502-2363 | |
| (434) 515-0503 | |
| (434) 237-0332 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 121 Farley Branch Drive, Lynchburg, Virginia |
| Authorized Official Name and Position | Stephanie Swain Tucker (OWNER/SOLE PRACTITIONER) |
| Authorized Official Contact | 4345150503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
121 Farley Branch Drive P.o. Box 4614 Lynchburg VA 24502-0614 Ph: (434) 515-0503 | 121 Farley Branch Drive Lynchburg VA 24502-2363 Ph: (434) 515-0503 |
| NPI Number | 1811322928 |
|---|---|
| Provider Enumeration Date | 09/09/2013 |
| Last Update Date | 11/16/2021 |
| Certification Date | 11/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811322928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | 0904007352 (Virginia) | Secondary |
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