Healthcare Provider Details

I. General information

NPI: 1881728012
Provider Name (Legal Business Name): TRIAD THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 N POINT BLVD SUITE 201
WINSTON SALEM NC
27106-3261
US

IV. Provider business mailing address

PO BOX 12595
WINSTON SALEM NC
27117-2595
US

V. Phone/Fax

Practice location:
  • Phone: 336-896-0904
  • Fax:
Mailing address:
  • Phone: 803-720-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001837
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. QUINCY ROCHELLE SMILING
Title or Position: CEO
Credential: PH.D.
Phone: 336-896-0904