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Organization
TRIAD BEHAVIORAL RESOURCES PC
Active
Organization
TRIAD BEHAVIORAL RESOURCES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BOLTON (CEO)
(910) 765-1003
Entity
Organization
Contact information
Practice address
12 N 5TH AVE, WILMINGTON, NC 28401-4537
(910) 765-1003
(910) 765-1004
Mailing address
12 N 5TH AVE, WILMINGTON, NC 28401-4537
(910) 765-1003
(910) 765-1004
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MHL041686
NC
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017U3
BLUE CROSS BLUE SHIELD
NC
05
—
6005083
—
NC
Enumeration date
01/19/2007
Last updated
09/28/2023
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