Individual provider Active NPI

Shanise S Tucker, LMSW, ADC, HRS

  • Addiction (Substance Use Disorder) Counselor
  • Summerville, SC
National Provider Identifier
1043163595
Registry record updated Feb 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
ADC-2360 Issued in SC
Practice address
1905 Central Ave # a
Summerville, SC 29483-9328
Phone
(843) 640-5470
NPI assigned
Feb 16, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 18466 SC
Addiction (Substance Use Disorder) Counselor 101YA0400X ADC-2360 SC Primary

Addresses

Primary practice location

1905 Central Ave # a
Summerville, SC 29483-9328

Mailing address

1905 Central Ave # a
Summerville, SC 29483-9328
Phone (843) 640-5470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ADC-2360SCMDAddiction (Substance Use Disorder) Counselor
18466SCMDNeurology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771200000000",
    "number": "1043163595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 CENTRAL AVE # A",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294839328",
            "telephone_number": "843-640-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CENTRAL AVE # A",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294839328",
            "telephone_number": "843-640-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "SHANISE",
        "middle_name": "S",
        "credential": "LMSW, ADC, HRS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-02-16",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SC",
            "license": "18466",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "SC",
            "license": "ADC-2360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.