Active NPI
Triumph LLC
- Clinical Social Worker
- Durham, NC
National Provider Identifier
1093880213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Legal business name
- TRIUMPH LLC
- Practice address
- 725 Broad St
Durham, NC 27705-4833 - Phone
- (919) 433-1491
- Fax
- (919) 433-1498
- NPI assigned
- Nov 22, 2006
- Organization subpart
- Yes
- Parent organization
- TRIUMPH LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Talesha Rollock
- Title
- Provider Enrollment Specialist
- Phone
- (919) 256-0824
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Psychologist | 103T00000X | |||
| Clinical Social Worker | 1041C0700X | Primary | ||
| Marriage & Family Therapist | 106H00000X |
Addresses
Primary practice location
725 Broad St
Durham, NC 27705-4833
Mailing address
3210 Fairhill Dr
Raleigh, NC 27612-3215
Phone (919) 256-0824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6005383 | Medicaid | NC |
National Provider Directory
National Provider Directory- Part of
- Triumph LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1240531200000",
"number": "1093880213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 FAIRHILL DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276123215",
"telephone_number": "919-256-0824",
"fax_number": "919-256-0833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 BROAD ST",
"city": "DURHAM",
"state": "NC",
"postal_code": "277054833",
"telephone_number": "919-433-1491",
"fax_number": "919-433-1498"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRIUMPH LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TRIUMPH LLC",
"enumeration_date": "2006-11-22",
"last_updated": "2009-04-24",
"status": "A",
"authorized_official_last_name": "ROLLOCK",
"authorized_official_first_name": "TALESHA",
"authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
"authorized_official_telephone_number": "919-256-0824"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6005383",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.