Provider Demographics
NPI:1932898459
Name:HALL-RUCKER, SHARON NICOLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:NICOLE
Last Name:HALL-RUCKER
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 1:1117 MATCHSTICK PL SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4718
Mailing Address - Country:US
Mailing Address - Phone:980-254-2489
Mailing Address - Fax:
Practice Address - Street 1:1117 MATCHSTICK PL SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4718
Practice Address - Country:US
Practice Address - Phone:980-254-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0155331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical