Healthcare Provider Details

I. General information

NPI: 1871844308
Provider Name (Legal Business Name): TARA MEREDITH ESCALANTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 DRESSER CT
RALEIGH NC
27609-7323
US

IV. Provider business mailing address

1055 DRESSER CT
RALEIGH NC
27609-7323
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-0987
  • Fax:
Mailing address:
  • Phone: 919-627-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008844
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: