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Organization
TRIUMPH LLC
Active
Organization
TRIUMPH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA FRAZIER (PROVIDER ENROLLMENT SPECIALIST)
(919) 256-0824
Entity
Organization
Contact information
Practice address
548 W RIDGEWAY ST, WARRENTON, NC 27589-1716
(252) 257-4071
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3220
(919) 256-0824
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005387
—
NC
Enumeration date
01/29/2007
Last updated
07/30/2007
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