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General NPI Number Information
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NPI Number | 1366318677
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Entity Type | Organization
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Legal Business Name | TRIAD WELLNESS & SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2031 MARTIN LUTHER KING JR DR STE F
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City | GREENSBORO
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State | NC
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Zip | 27406-3342
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Country | US
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Telephone | 336-609-9102
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Fax | 336-904-2354
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Provider Business Mailing Address
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Address Line | 2031 SUITE F MARTIN LUTHER KING JR. DRIVE
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City | GREENSBORO
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State | NC
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Zip | 27406
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Country | US
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Telephone | 336-609-9102
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Fax | 336-904-2354
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Authorized Official
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Title or Position | OWNER/CEO
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Name | TRI-SHAWN DANZELLE DRAUGHON
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Credential |
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Telephone | 336-609-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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