Provider Demographics
NPI:1114316676
Name:EPIPHANY COUNSELING GUIDANCE AND TREATMENT SERVICES
Entity Type:Organization
Organization Name:EPIPHANY COUNSELING GUIDANCE AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-788-7400
Mailing Address - Street 1:8484 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4308
Mailing Address - Country:US
Mailing Address - Phone:678-788-7400
Mailing Address - Fax:678-954-6896
Practice Address - Street 1:3555 MERCER UNIVERSITY DR
Practice Address - Street 2:SUITE 101-6
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-4940
Practice Address - Country:US
Practice Address - Phone:678-788-7400
Practice Address - Fax:678-954-6896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPIPHANY COUNSELING GUIDANCE AND TREATMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-21
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14-000385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty