Provider Demographics
NPI:1265697122
Name:TRINITY INNOVATIVE PROGRAMMING SERVICES, INC.
Entity type:Organization
Organization Name:TRINITY INNOVATIVE PROGRAMMING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:CHARELL
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-977-3696
Mailing Address - Street 1:100 HAY ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5676
Mailing Address - Country:US
Mailing Address - Phone:910-677-0014
Mailing Address - Fax:910-677-0013
Practice Address - Street 1:100 HAY ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5676
Practice Address - Country:US
Practice Address - Phone:910-677-0014
Practice Address - Fax:910-677-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NC61066191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty