Healthcare Provider Details

I. General information

NPI: 1770320855
Provider Name (Legal Business Name): TRIUMPH HOLISTIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N ROBINSON ST STE 402
RICHMOND VA
23220-4462
US

IV. Provider business mailing address

PO BOX 265
JARRATT VA
23867-0265
US

V. Phone/Fax

Practice location:
  • Phone: 804-404-6602
  • Fax: 804-258-4740
Mailing address:
  • Phone: 804-404-6602
  • Fax: 804-258-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TIERRA LUCAS
Title or Position: CEO
Credential: LCSW
Phone: 804-252-9456