Healthcare Provider Details

I. General information

NPI: 1316578917
Provider Name (Legal Business Name): EPEC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD STE 106
ROSEDALE MD
21237-4335
US

IV. Provider business mailing address

9106 PHILADELPHIA RD STE 106
ROSEDALE MD
21237-4335
US

V. Phone/Fax

Practice location:
  • Phone: 443-559-8354
  • Fax:
Mailing address:
  • Phone: 443-559-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEKEYA HUTTON
Title or Position: OWNER
Credential: CRNP
Phone: 443-559-8354