Healthcare Provider Details

I. General information

NPI: 1780575704
Provider Name (Legal Business Name): TERESA L VIGARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 2ND AVE S STE 431
NORTH MYRTLE BEACH SC
29582-8105
US

IV. Provider business mailing address

559 COLEMAN CEMETARY RD
CERRO GORDO NC
28430-9455
US

V. Phone/Fax

Practice location:
  • Phone: 843-890-4100
  • Fax:
Mailing address:
  • Phone: 843-251-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17316
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: