Provider Demographics
NPI:1730520560
Name:SCARBOROUGH, THERESA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 FRIAR TUCK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3653
Mailing Address - Country:US
Mailing Address - Phone:910-581-1212
Mailing Address - Fax:
Practice Address - Street 1:1205 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-514-9493
Practice Address - Fax:336-395-8501
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC010851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker