Healthcare Provider Details

I. General information

NPI: 1003375346
Provider Name (Legal Business Name): TRIANGLE WELLNESS & RECOVERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DARRINGTON DR STE 204
CARY NC
27513-8134
US

IV. Provider business mailing address

1000 DARRINGTON DR STE 204
CARY NC
27513-8134
US

V. Phone/Fax

Practice location:
  • Phone: 919-388-5621
  • Fax:
Mailing address:
  • Phone: 919-338-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA KOENIG
Title or Position: CEO & MEDICAL DIRECTOR
Credential: MD,MBA
Phone: 505-377-5406