Provider Demographics
NPI:1154952836
Name:OJEDA, TRYNITY LEE
Entity type:Individual
Prefix:
First Name:TRYNITY
Middle Name:LEE
Last Name:OJEDA
Suffix:
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 1:1500 LAKE FRONT DR APT K
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3470
Mailing Address - Country:US
Mailing Address - Phone:571-247-8173
Mailing Address - Fax:
Practice Address - Street 1:1240 SE MAYNARD RD STE 203
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6946
Practice Address - Country:US
Practice Address - Phone:919-636-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26119101YA0400X
NCA15519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)