Provider Demographics
NPI:1881183085
Name:TUCKER, ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 GRIFFIN DR
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-8020
Mailing Address - Country:US
Mailing Address - Phone:919-749-1087
Mailing Address - Fax:
Practice Address - Street 1:119 GRIFFIN DR
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-8020
Practice Address - Country:US
Practice Address - Phone:919-749-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0093161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC009316OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD