Healthcare Provider Details

I. General information

NPI: 1548622004
Provider Name (Legal Business Name): EPIPHANY FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BROAD ST
SUMTER SC
29150-4102
US

IV. Provider business mailing address

212 BROAD ST
SUMTER SC
29150-4102
US

V. Phone/Fax

Practice location:
  • Phone: 704-236-4067
  • Fax: 803-324-0201
Mailing address:
  • Phone: 704-236-4067
  • Fax: 803-324-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VERA MILLNER
Title or Position: CEO
Credential: CSAC
Phone: 704-236-4067