Provider Demographics
NPI:1902938640
Name:BOOKER, TRICIA HART (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:HART
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 RAYS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28376
Mailing Address - Country:US
Mailing Address - Phone:910-949-2924
Mailing Address - Fax:
Practice Address - Street 1:241 GRANT ST
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-673-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCLCSW C0042851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002557Medicaid
NC6002574Medicaid
EH5000104OtherFIRST CAROLINA CARE
NC141E4OtherBCBS
NC185341OtherMED COST