Healthcare Provider Details

I. General information

NPI: 1164339602
Provider Name (Legal Business Name): MICHELLE MARIE TEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W WILLIAMS ST STE 106
APEX NC
27502-3979
US

IV. Provider business mailing address

1011 W WILLIAMS ST STE 106
APEX NC
27502-3979
US

V. Phone/Fax

Practice location:
  • Phone: 919-386-0402
  • Fax: 919-882-0931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024011
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: