Provider Demographics
NPI:1780575704
Name:VIGARI, TERESA L
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:VIGARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 COLEMAN CEMETARY RD
Mailing Address - Street 2:
Mailing Address - City:CERRO GORDO
Mailing Address - State:NC
Mailing Address - Zip Code:28430-9455
Mailing Address - Country:US
Mailing Address - Phone:843-251-4172
Mailing Address - Fax:
Practice Address - Street 1:1000 2ND AVE S STE 431
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-8105
Practice Address - Country:US
Practice Address - Phone:843-890-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker