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General NPI Number Information
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NPI Number | 1073496899
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Entity Type | Individual
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Provider Name | TEAERIA GILLAM LCSWA
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 7540 RAMBLE WAY STE 109
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City | RALEIGH
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State | NC
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Zip | 27616-4318
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Country | US
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Telephone | 919-295-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 MULFORD CT UNIT 1460
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City | KNIGHTDALE
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State | NC
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Zip | 27545-0260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P022632
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License Number State | NC
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