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General NPI Number Information
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NPI Number | 1558839480
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Entity Type | Organization
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Legal Business Name | EPIPHANY PLACE COUNSELING & CONSULTING PLLC
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 690 N REILLY RD STE 8
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5734
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Country | US
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Telephone | 910-689-6567
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Fax |
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Provider Business Mailing Address
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Address Line | 58 BLAKELY CT
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City | LILLINGTON
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State | NC
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Zip | 27546-9620
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Country | US
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Telephone | 910-689-6567
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EBONY RENEE BROWN
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Credential | MSW, LCSW
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Telephone | 910-689-6567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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