Provider Demographics
NPI:1952010910
Name:TUCKER, E'ZAVIAL D (LCSW-A)
Entity type:Individual
Prefix:MS
First Name:E'ZAVIAL
Middle Name:D
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 FOX MEADOW LN APT 1248
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-7668
Mailing Address - Country:US
Mailing Address - Phone:252-567-0012
Mailing Address - Fax:
Practice Address - Street 1:7001 FOX MEADOW LN APT 1248
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-7668
Practice Address - Country:US
Practice Address - Phone:252-567-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0182361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical