Provider Demographics
NPI:1316317969
Name:TUCKER, SHARON PAYNE (LICSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:PAYNE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5313
Mailing Address - Country:US
Mailing Address - Phone:256-764-3431
Mailing Address - Fax:256-768-7462
Practice Address - Street 1:635 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5313
Practice Address - Country:US
Practice Address - Phone:256-764-3431
Practice Address - Fax:256-768-7462
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4208C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4208COtherTHE STATE OF AL BOARD OF SOCIAL WORK EXAMINERS