Provider Demographics
NPI:1477751337
Name:TUCKER, ALLISON MOORE (LCSW, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MOORE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CRAMERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28032-1528
Mailing Address - Country:US
Mailing Address - Phone:704-860-3386
Mailing Address - Fax:
Practice Address - Street 1:1977 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4528
Practice Address - Country:US
Practice Address - Phone:704-503-3535
Practice Address - Fax:704-593-5555
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0065001041C0700X
NC1347101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147KAOtherBLUECROSS BLUESHIELD
NC6112060Medicaid