Active NPI
Triumph, LLC
- Clinical Social Worker
- N Wilkesboro, NC
National Provider Identifier
1255483285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Legal business name
- TRIUMPH, LLC
- Practice address
- 207 10TH St
Suite 201
N Wilkesboro, NC 28659-4153 - Phone
- (336) 667-1440
- Fax
- (336) 667-1489
- NPI assigned
- Jan 18, 2007
- Last updated
- Feb 26, 2009
- 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
- Mrs. Talesha Rollock
- Title
- Provider Enrollment Specialist
- Phone
- (919) 256-0824
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | NU | ||
| Psychologist | 103T00000X | NU | ||
| Clinical Social Worker | 1041C0700X | NU | Primary | |
| Marriage & Family Therapist | 106H00000X | NU |
Addresses
Primary practice location
207 10TH St
Suite 201
N Wilkesboro, NC 28659-4153
Mailing address
3210 Fairhill Dr
Raleigh, NC 27612-3215
Phone (919) 256-0824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6005574 | 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": "1169078400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1235606400000",
"number": "1255483285",
"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": "207 10TH ST",
"address_2": "SUITE 201",
"city": "N WILKESBORO",
"state": "NC",
"postal_code": "286594153",
"telephone_number": "336-667-1440",
"fax_number": "336-667-1489"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRIUMPH, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TRIUMPH, LLC",
"enumeration_date": "2007-01-18",
"last_updated": "2009-02-26",
"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",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6005574",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in N Wilkesboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.