Individual
MARY TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
418 PERSON ST STE 103, FAYETTEVILLE, NC 28301-5886
(910) 483-0958
(910) 483-1720
Mailing address
134 GOWENS RD, BLADENBORO, NC 28320-5878
(910) 483-0958
(910) 483-1720
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC-32741
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0Y00X
—
NC
Enumeration date
05/04/2026
Last updated
05/04/2026
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