Healthcare Provider Details

I. General information

NPI: 1518108430
Provider Name (Legal Business Name): EPIC SUPPORTS AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N MAIN ST 2ND FLOOR OFFICE #1
TARBORO NC
27886-5056
US

IV. Provider business mailing address

602 CIRCLE DR
GREENVILLE NC
27858-8508
US

V. Phone/Fax

Practice location:
  • Phone: 252-641-1620
  • Fax:
Mailing address:
  • Phone: 252-341-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERNESTINE SMITH TAYLOR
Title or Position: DIRECTOR
Credential:
Phone: 252-341-2397