MEDICARE: TRIAD WELLNESS & SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency
3	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1366318677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAD WELLNESS & SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	2031 SUITE F MARTIN LUTHER KING JR. DRIVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406
Country	:	US
Telephone Number	:	336-609-9102
Fax Number	:	336-904-2354

Provider Business Practice Location Address
First Line	:	2031 MARTIN LUTHER KING JR DR STE F
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-3342
Country	:	US
Telephone Number	:	336-609-9102
Fax Number	:	336-904-2354

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	TRI-SHAWN DANZELLE DRAUGHON
Credential	:
Telephone Number	:	336-609-9102

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	01/07/2026

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