Provider Demographics
NPI:1902136021
Name:TELJAM PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:TELJAM PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TELIA
Authorized Official - Middle Name:YEVETTE
Authorized Official - Last Name:VIRGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-841-3675
Mailing Address - Street 1:65 GLEN RD
Mailing Address - Street 2:PMB 646
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7943
Mailing Address - Country:US
Mailing Address - Phone:919-841-3675
Mailing Address - Fax:919-779-4498
Practice Address - Street 1:65 GLEN RD
Practice Address - Street 2:PMB 646
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7943
Practice Address - Country:US
Practice Address - Phone:919-841-3675
Practice Address - Fax:919-779-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005273251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management