Provider Demographics
NPI:1003225640
Name:EPIC CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:EPIC CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEQUILLA
Authorized Official - Middle Name:JANISSE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-447-6007
Mailing Address - Street 1:913 MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3096
Mailing Address - Country:US
Mailing Address - Phone:404-447-6007
Mailing Address - Fax:
Practice Address - Street 1:913 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3096
Practice Address - Country:US
Practice Address - Phone:404-447-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004994251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health