Healthcare Provider Details

I. General information

NPI: 1902304991
Provider Name (Legal Business Name): TAJAE THOMAS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date: 04/26/2018
Reactivation Date: 06/05/2018

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 220
MORRISVILLE NC
27560-5490
US

V. Phone/Fax

Practice location:
  • Phone: 919-571-5174
  • Fax: 919-363-7697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012430
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013300
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: