Tabu Keyunga Medju

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P013357 Issued in NC

Practice address

1526 Mark Massengill Dr
Raleigh, NC 27610-4454

Phone

(919) 231-9969

NPI assigned

Jul 8, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1205498599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 MARK MASSENGILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276104454",
            "telephone_number": "919-231-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 MARK MASSENGILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276104454",
            "telephone_number": "919-231-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDJU",
        "first_name": "TABU",
        "middle_name": "KEYUNGA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "26832",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P013357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaicie Medina
• Carol Mary Medins, MPH, RD, LDN, CNSC
• Medique Medical Equipment Supply, Inc.
• Meditelecare of North Carolina PLLC
• Paul Ilolibi Medju, LCSW
• Cheryl Medley, MA. CCC-A
• Cara Peterson Medlin, BSN, RN, CCRN
• Chasity Marie Medlin
• Keri Medlin, PHARM.D
• Medox Healthcare Inc

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.