Healthcare Provider Details

I. General information

NPI: 1558154419
Provider Name (Legal Business Name): CIERA EDMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8392 SIX FORKS RD STE 203
RALEIGH NC
27615-3061
US

IV. Provider business mailing address

920 WAKE TOWNE DR APT 210
RALEIGH NC
27609-7898
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-3603
  • Fax:
Mailing address:
  • Phone: 434-906-7379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022027
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: