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General NPI Number Information
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NPI Number | 1265697122
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Entity Type | Organization
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Legal Business Name | TRINITY INNOVATIVE PROGRAMMING SERVICES, INC.
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 100 HAY ST SUITE 1000
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5676
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Country | US
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Telephone | 910-677-0014
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Fax | 910-677-0013
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Provider Business Mailing Address
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Address Line | 100 HAY ST SUITE 1000
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5676
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Country | US
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Telephone | 910-677-0014
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Fax | 910-677-0013
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DARIUS CHARELL MONROE
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Credential |
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Telephone | 910-977-3696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6106619
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License Number State | NC
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