Provider Demographics
NPI:1851689400
Name:TRIANGLE CENTER FOR EMOTIONAL WELLNESS,PLLC
Entity Type:Organization
Organization Name:TRIANGLE CENTER FOR EMOTIONAL WELLNESS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUR-RAZZAQ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-408-7839
Mailing Address - Street 1:5011 SOUTHPARK DR
Mailing Address - Street 2:SU. 130
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7738
Mailing Address - Country:US
Mailing Address - Phone:919-408-7839
Mailing Address - Fax:919-361-1900
Practice Address - Street 1:5011 SOUTHPARK DR
Practice Address - Street 2:SU. 130
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7738
Practice Address - Country:US
Practice Address - Phone:919-408-7839
Practice Address - Fax:919-361-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102831Medicaid