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Organization

TRIUMPH LLC

Active
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Organization

TRIUMPH LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TALESHA ROLLOCK (PROVIDER ENROLLMENT SPECIALIST)
(919) 256-0824
Entity
Organization

Contact information

Practice address
5505 CREEDMOOR RD, SUITE 100, RALEIGH, NC 27612-6333
(919) 852-5352
(919) 852-5323
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3215
(919) 256-0824

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1041C0700X
Clinical Social Worker
Primary
106H00000X
Marriage & Family Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6005382
NC
Enumeration date
01/25/2007
Last updated
04/23/2009
About Stedi
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