| Organization Name: | TRIUMPH, LLC |
| NPI Number: | 1134399652 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TALESHA ROLLOCK (PROVIDER ENROLLMENT SPECIALIST) |
| Mailing Address: | 355 S Madison Blvd Suite C2 Roxboro |
| State: | NC US |
| Postal Code: | 275735485 |
| Phone Number: | 3365972065 |
| Fax Number: | 3365972116 |
| NPI Enumeration Date: | 03/12/2008 |
| NPI Last Update Date: | 02/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |