Healthcare Provider Details

I. General information

NPI: 1265395263
Provider Name (Legal Business Name): TRIARBOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 LAMPLIGHTER RD.
OAK HILL WV
25901-9998
US

IV. Provider business mailing address

98 LAMPLIGHTER RD.
OAK HILL WV
25901-9998
US

V. Phone/Fax

Practice location:
  • Phone: 304-207-0687
  • Fax:
Mailing address:
  • Phone: 304-207-0687
  • 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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GRACE I. KOMOLAFE
Title or Position: CEO/OWNER
Credential: MD
Phone: 304-207-0687