Provider Demographics
NPI:1366318677
Name:TRIAD WELLNESS & SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:TRIAD WELLNESS & SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRI-SHAWN
Authorized Official - Middle Name:DANZELLE
Authorized Official - Last Name:DRAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-609-9102
Mailing Address - Street 1:2031 SUITE F MARTIN LUTHER KING JR. DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406
Mailing Address - Country:US
Mailing Address - Phone:336-609-9102
Mailing Address - Fax:336-904-2354
Practice Address - Street 1:2031 MARTIN LUTHER KING JR DR STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3342
Practice Address - Country:US
Practice Address - Phone:336-609-9102
Practice Address - Fax:336-904-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty