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General NPI Number Information
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NPI Number | 1265395263
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Entity Type | Organization
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Legal Business Name | TRIARBOR WELLNESS
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 98 LAMPLIGHTER RD.
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City | OAK HILL
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State | WV
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Zip | 25901-9998
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Country | US
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Telephone | 304-207-0687
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Fax |
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Provider Business Mailing Address
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Address Line | 98 LAMPLIGHTER RD.
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City | OAK HILL
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State | WV
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Zip | 25901-9998
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Country | US
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Telephone | 304-207-0687
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. GRACE I. KOMOLAFE
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Credential | MD
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Telephone | 304-207-0687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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