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General NPI Number Information
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NPI Number | 1518108430
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Entity Type | Organization
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Legal Business Name | EPIC SUPPORTS AND SERVICES
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 99 N MAIN ST 2ND FLOOR OFFICE #1
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City | TARBORO
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State | NC
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Zip | 27886-5056
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Country | US
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Telephone | 252-641-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 602 CIRCLE DR
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City | GREENVILLE
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State | NC
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Zip | 27858-8508
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Country | US
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Telephone | 252-341-2397
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERNESTINE SMITH TAYLOR
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Credential |
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Telephone | 252-341-2397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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