Provider Demographics
NPI:1417409319
Name:EPIPHANY FAMILY SERVICES LLC MARYLAND
Entity Type:Organization
Organization Name:EPIPHANY FAMILY SERVICES LLC MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:704-236-4067
Mailing Address - Street 1:568 ANDERSON RD N
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7300
Mailing Address - Country:US
Mailing Address - Phone:704-236-4067
Mailing Address - Fax:
Practice Address - Street 1:568 ANDERSON RD N
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7300
Practice Address - Country:US
Practice Address - Phone:704-236-4067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health