=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972465987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPIPHANY HOLISTIC WELLNESS STUDIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2025
-----------------------------------------------------
Last Update Date | 11/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6545 MARKET AVE N STE 100
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44721-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-957-1689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6545 MARKET AVE N STE 100
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44721-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, COUNSELOR
-----------------------------------------------------
Name | IMANI YAHYA
-----------------------------------------------------
Credential | MAED, LPC
-----------------------------------------------------
Telephone | 330-957-1689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------