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General NPI Number Information
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NPI Number | 1427430313
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Entity Type | Organization
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Legal Business Name | THE EPIPHANY CENTER
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 408 E MARKET ST SUITE 201B #2
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5261
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Country | US
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Telephone | 404-579-9763
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Fax |
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Provider Business Mailing Address
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Address Line | 408 E MARKET ST SUITE 201B #2
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5261
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Country | US
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Telephone | 404-579-9763
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/THERAPIST
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Name | MRS. JESSICA L. JENNINGS
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Credential | LPC, CADC
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Telephone | 404-579-9763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0701004672
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004672
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License Number State | VA
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