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Individual

SHANISE S TUCKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMSW, ADC, HRS

Contact information

Practice address
1905 CENTRAL AVE # A, SUMMERVILLE, SC 29483-9328
(843) 640-5470
Mailing address
1905 CENTRAL AVE # A, SUMMERVILLE, SC 29483-9328
(843) 640-5470

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ADC-2360
SC
104100000X
Social Worker
18466
SC

Other

Enumeration date
02/16/2026
Last updated
02/16/2026
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