Provider Demographics
NPI:1639244023
Name:RICKS, KARREN BOONE (LCSW)
Entity Type:Individual
Prefix:
First Name:KARREN
Middle Name:BOONE
Last Name:RICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NC
Mailing Address - Zip Code:27845-9744
Mailing Address - Country:US
Mailing Address - Phone:252-534-9977
Mailing Address - Fax:
Practice Address - Street 1:9486 HWY 305
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845-9679
Practice Address - Country:US
Practice Address - Phone:252-534-5111
Practice Address - Fax:252-534-1027
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106320Medicaid
NC14113OtherBLUE CROSS BLUE SHIELD