Basic Information
Provider Information
NPI: 1710353610
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRIPP
FirstName: HELEN
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential: LPCA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 309 CRUTCHFIELD ST
Address2:  
City: DURHAM
State: NC
PostalCode: 277042754
CountryCode: US
TelephoneNumber: 9195607305
FaxNumber: 9195601760
Practice Location
Address1: 309 CRUTCHFIELD ST
Address2:  
City: DURHAM
State: NC
PostalCode: 277042754
CountryCode: US
TelephoneNumber: 9195607305
FaxNumber: 9195601760
Other Information
ProviderEnumerationDate: 08/13/2015
LastUpdateDate: 08/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XA11538NCY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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