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Organization
TRIAD OUTREACH LLC
Active
Organization
TRIAD OUTREACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WALTON (OWNER)
(336) 615-6738
Entity
Organization
Contact information
Practice address
4533 VERNON CIR, KERNERSVILLE, NC 27284-0136
(336) 615-6738
Mailing address
4533 VERNON CIR, KERNERSVILLE, NC 27284-0136
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
NULL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
NULL
207QA0505X
Adult Medicine Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
Other
Enumeration date
01/23/2021
Last updated
01/23/2021
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