Provider Demographics
NPI:1922323641
Name:TRIAD THERAPY MENTAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:TRIAD THERAPY MENTAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-7774
Mailing Address - Street 1:131B DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5470
Mailing Address - Country:US
Mailing Address - Phone:336-629-7774
Mailing Address - Fax:336-629-7776
Practice Address - Street 1:131B DAVIS ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5470
Practice Address - Country:US
Practice Address - Phone:336-629-7774
Practice Address - Fax:336-629-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302314BMedicaid
NC8302846BMedicaid