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General NPI Number Information
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NPI Number | 1588057798
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Entity Type | Organization
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Legal Business Name | EPIPHANY MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 916 BRANCH ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-5708
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Country | US
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Telephone | 252-985-0078
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Fax | 252-446-6645
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Provider Business Mailing Address
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Address Line | 916 BRANCH ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-5708
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Country | US
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Telephone | 252-985-0078
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Fax | 252-446-6645
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. DIANNE FAYE WILLIAMS
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Credential | LPC
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Telephone | 252-435-5016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5054
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License Number State | NC
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