Provider Demographics
NPI:1083815070
Name:TRIANA, JILL ALISSA (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ALISSA
Last Name:TRIANA
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 CARDIGAN PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6475
Mailing Address - Country:US
Mailing Address - Phone:919-782-6957
Mailing Address - Fax:
Practice Address - Street 1:3800 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5237
Practice Address - Country:US
Practice Address - Phone:919-760-8427
Practice Address - Fax:919-760-2383
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4613101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor