Healthcare Provider Details

I. General information

NPI: 1861007882
Provider Name (Legal Business Name): GER VUE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HIGHWOODS BLVD STE 310
RALEIGH NC
27604-1029
US

IV. Provider business mailing address

2708 VERDE DR APT F
RALEIGH NC
27603-3283
US

V. Phone/Fax

Practice location:
  • Phone: 919-714-7500
  • Fax:
Mailing address:
  • Phone: 919-949-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: