MEDICARE: ETERICA DIONNE SIMS-RUCKS LCSW

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
1	1041C0700X	Clinical Social Worker	CSW004169	GA

General Provider Information

NPI Number	:	1366772485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETERICA DIONNE SIMS-RUCKS LCSW

Provider Business Mailing Address
First Line	:	3485 N DESERT DR # 205
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-5724
Country	:	US
Telephone Number	:	404-721-6716
Fax Number	:	866-830-7199

Provider Business Practice Location Address
First Line	:	3113 ABBEY DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5477
Country	:	US
Telephone Number	:	404-423-5900
Fax Number	:	866-830-7199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	10/14/2012

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