Provider Demographics
NPI:1558839480
Name:EPIPHANY PLACE COUNSELING & CONSULTING PLLC
Entity Type:Organization
Organization Name:EPIPHANY PLACE COUNSELING & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:910-689-6567
Mailing Address - Street 1:58 BLAKELY CT
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9620
Mailing Address - Country:US
Mailing Address - Phone:910-689-6567
Mailing Address - Fax:
Practice Address - Street 1:690 N REILLY RD STE 8
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5734
Practice Address - Country:US
Practice Address - Phone:910-689-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty