Healthcare Provider Details

I. General information

NPI: 1245919331
Provider Name (Legal Business Name): CHRISTINE M RUCKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 TIDEWATER DR
NORFOLK VA
23505-3845
US

IV. Provider business mailing address

400 WARREN CRES APT 3
NORFOLK VA
23507-2242
US

V. Phone/Fax

Practice location:
  • Phone: 757-664-6670
  • Fax:
Mailing address:
  • Phone: 757-769-1796
  • Fax: 757-655-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019619
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: