Provider Demographics
NPI:1588833701
Name:TRIAD THERAPY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:TRIAD THERAPY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-896-0904
Mailing Address - Street 1:350 N COX ST STE 16
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5514
Mailing Address - Country:US
Mailing Address - Phone:336-629-7774
Mailing Address - Fax:336-629-7776
Practice Address - Street 1:315 MAIN ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4401
Practice Address - Country:US
Practice Address - Phone:336-990-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC641001Medicaid