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General NPI Number Information
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NPI Number | 1265741417
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Entity Type | Organization
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Legal Business Name | TRIAD THERAPY MENTAL HEALTH CENTER, LLC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 131B DAVIS ST
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City | ASHEBORO
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State | NC
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Zip | 27203-5470
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Country | US
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Telephone | 336-629-7774
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Fax | 336-629-7776
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Provider Business Mailing Address
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Address Line | 131B DAVIS ST
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City | ASHEBORO
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State | NC
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Zip | 27203-5470
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Country | US
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Telephone | 336-629-7774
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Fax | 336-629-7776
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. QUINCY SMILING
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Credential | PH.D.
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Telephone | 336-629-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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