Healthcare Provider Details

I. General information

NPI: 1427100411
Provider Name (Legal Business Name): TALITHA ROXANNE PERKINS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TALITHA ROXANNE LEGER

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT LIBERTY NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVE
FORT LIBERTY NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-908-8318
  • Fax:
Mailing address:
  • Phone: 910-908-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011387
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: