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
103TC0700X
Clinical Psychologist
—
NC
1041C0700X
Clinical Social Worker
—
NC
2084P0800X
Psychiatry Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5905083
—
NC
Enumeration date
01/25/2007
Last updated
03/02/2009
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