Provider Demographics
NPI:1265816086
Name:TRIANGLE MARRIAGE AND FAMILY LIFE CENTER
Entity Type:Organization
Organization Name:TRIANGLE MARRIAGE AND FAMILY LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-267-6747
Mailing Address - Street 1:3761 NW CARY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3761 NW CARY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8438
Practice Address - Country:US
Practice Address - Phone:919-267-6747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)