| Organization Name: | TRIUMPH, LLC |
| NPI Number: | 1255483285 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TALESHA ROLLOCK (PROVIDER ENROLLMENT SPECIALIST) |
| Mailing Address: | 207 10th St Suite 201 N Wilkesboro |
| State: | NC US |
| Postal Code: | 286594153 |
| Phone Number: | 3366671440 |
| Fax Number: | 3366671489 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 02/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |