Healthcare Provider Details

I. General information

NPI: 1942241013
Provider Name (Legal Business Name): VALARIE TUCKER GARDNER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 DURHAM RD SUITE A
WAKE FOREST NC
27587-8793
US

IV. Provider business mailing address

825 CLATTER AVE
WAKE FOREST NC
27587-4632
US

V. Phone/Fax

Practice location:
  • Phone: 919-570-3004
  • Fax: 919-570-9225
Mailing address:
  • Phone: 919-562-7747
  • Fax: 919-570-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: