Healthcare Provider Details

I. General information

NPI: 1487564530
Provider Name (Legal Business Name): TRIUMPH OUTREACH MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 LEXINGTON AVE STE 5
THOMASVILLE NC
27360-3578
US

IV. Provider business mailing address

703 LEXINGTON AVE STE 5
THOMASVILLE NC
27360-3578
US

V. Phone/Fax

Practice location:
  • Phone: 704-352-3662
  • Fax:
Mailing address:
  • Phone: 704-352-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LATASHA GIDDERON
Title or Position: TREASURER
Credential: CPSS
Phone: 704-200-8751