Provider Demographics
NPI:1073496899
Name:GILLAM, TEAERIA (LCSWA)
Entity type:Individual
Prefix:
First Name:TEAERIA
Middle Name:
Last Name:GILLAM
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:TEAERIA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 MULFORD CT UNIT 1460
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-0260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7540 RAMBLE WAY STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4318
Practice Address - Country:US
Practice Address - Phone:919-295-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP022632104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker