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General NPI Number Information
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NPI Number | 1881728012
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Entity Type | Organization
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Legal Business Name | TRIAD THERAPY, LLC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 7830 N POINT BLVD SUITE 201
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3261
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Country | US
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Telephone | 336-896-0904
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12595
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City | WINSTON SALEM
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State | NC
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Zip | 27117-2595
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Country | US
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Telephone | 803-720-4028
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. QUINCY ROCHELLE SMILING
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Credential | PH.D.
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Telephone | 336-896-0904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | C001837
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License Number State | NC
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Taxonomy #3
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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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