Provider Demographics
NPI:1487216107
Name:RICKERT, CIARA DANIELLE (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:CIARA
Middle Name:DANIELLE
Last Name:RICKERT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TREY LN
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-9435
Mailing Address - Country:US
Mailing Address - Phone:336-847-7405
Mailing Address - Fax:
Practice Address - Street 1:2309 W CONE BLVD STE 150A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4066
Practice Address - Country:US
Practice Address - Phone:336-701-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0136231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical