Healthcare Provider Details

I. General information

NPI: 1255640645
Provider Name (Legal Business Name): EPIPHANY FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2010
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CHURCH ST NE
CONCORD NC
28025-4733
US

IV. Provider business mailing address

6900 FARMINGDALE DR
CHARLOTTE NC
28212-5551
US

V. Phone/Fax

Practice location:
  • Phone: 704-536-6853
  • Fax: 704-445-4582
Mailing address:
  • Phone: 704-536-6853
  • Fax: 704-536-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: KATY MILLNER-CATHCART
Title or Position: OPERATIONS OFFICER
Credential: MHA
Phone: 704-536-6853