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Organization
TRIUMPH, LLC
Active
Organization
TRIUMPH, LLC
Active
Parent organization
TRIUMPH, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRIUMPH, LLC
Authorized official
MRS. TALESHA ROLLOCK (PROVIDER ENROLLMENT SPECIALIST)
(919) 256-0824
Entity
Organization
Contact information
Practice address
207 10TH ST, SUITE 201, N WILKESBORO, NC 28659-4153
(336) 667-1440
(336) 667-1489
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3215
(919) 256-0824
(919) 256-0833
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005574
—
NC
Enumeration date
01/18/2007
Last updated
02/26/2009
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