Provider Demographics
NPI:1720804073
Name:LUCKADOO, ANNE (MSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:LUCKADOO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7013
Mailing Address - Country:US
Mailing Address - Phone:704-648-4376
Mailing Address - Fax:
Practice Address - Street 1:2005 FLINT LN
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3334
Practice Address - Country:US
Practice Address - Phone:980-522-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0214891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical