Active NPI
M. Theresa Palmer, LCSW, LMFT
- Marriage & Family Therapist
- Winston Salem, NC
National Provider Identifier
1205956133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 868
- Practice address
- 1001 Reynolda Rd
Winston Salem, NC 27104-3245 - Phone
- (336) 721-7619
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C003718 | NC | |
| Marriage & Family Therapist | 106H00000X | 868 | NC | Primary |
Addresses
Primary practice location
1001 Reynolda Rd
Winston Salem, NC 27104-3245
Mailing address
1001 Reynolda Rd
Winston Salem, NC 27104-3245
Phone (336) 721-7619
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6002584 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C003718 | NC | MD | Clinical Social Worker |
| 868 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1205956133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 REYNOLDA RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271043245",
"telephone_number": "336-721-7619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 REYNOLDA RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271043245",
"telephone_number": "336-721-7619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALMER",
"first_name": "M.",
"middle_name": "THERESA",
"credential": "LCSW, LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C003718",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "868",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6002584",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.