Provider Demographics
NPI:1518674431
Name:TRIPLIN, JEROME II
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:TRIPLIN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 WINGMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7111
Mailing Address - Country:US
Mailing Address - Phone:336-420-5715
Mailing Address - Fax:
Practice Address - Street 1:7715 WINGMONT DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7111
Practice Address - Country:US
Practice Address - Phone:336-420-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist