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NPI Code Detail

MEDICARE: MARY TUCKER

MEDICARE: MARY TUCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCADC-32741NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255278578
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY TUCKER
Provider Business Mailing Address
First Line : 134 GOWENS RD
Second Line :
City : BLADENBORO
State : NC
Zip : 28320-5878
Country : US
Telephone Number : 910-483-0958
Fax Number : 910-483-1720
Provider Business Practice Location Address
First Line : 418 PERSON ST STE 103
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-5886
Country : US
Telephone Number : 910-483-0958
Fax Number : 910-483-1720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ MARY TUCKER ” Practice Location

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