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General NPI Number Information
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NPI Number | 1760918601
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Entity Type | Organization
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Legal Business Name | EPIPHANY COUNSELING SERVICE
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 30 BEACH RD SUITE 3
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City | WOLCOTT
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State | CT
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Zip | 06716-1902
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Country | US
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Telephone | 203-390-1468
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BEACH RD SUITE 3
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City | WOLCOTT
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State | CT
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Zip | 06716-1902
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Country | US
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Telephone | 203-390-1468
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | JADA I BROWN
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Credential | LPC
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Telephone | 203-390-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002489
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License Number State | CT
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