Provider Demographics
NPI:1285938423
Name:TRIANGLE LEARNING AND DEVELOPMENT RESOURCES PC
Entity type:Organization
Organization Name:TRIANGLE LEARNING AND DEVELOPMENT RESOURCES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:919-886-4437
Mailing Address - Street 1:209 LLOYD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1857
Mailing Address - Country:US
Mailing Address - Phone:919-886-4437
Mailing Address - Fax:919-928-5097
Practice Address - Street 1:209 LLOYD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1857
Practice Address - Country:US
Practice Address - Phone:919-886-4437
Practice Address - Fax:919-928-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008389Medicaid