Provider Demographics
NPI:1659267326
Name:T-3 TRAUMA TO TRIUMPH
Entity type:Organization
Organization Name:T-3 TRAUMA TO TRIUMPH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIONTWANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK-PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-643-0663
Mailing Address - Street 1:5555 POCASSETT WAY
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-8723
Mailing Address - Country:US
Mailing Address - Phone:517-643-0663
Mailing Address - Fax:
Practice Address - Street 1:5555 POCASSETT WAY
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-8723
Practice Address - Country:US
Practice Address - Phone:517-643-0663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty