Provider Demographics
NPI:1578088753
Name:EPPERSON, TRINA YOLANDA (BS, CADC- US)
Entity Type:Individual
Prefix:MS
First Name:TRINA
Middle Name:YOLANDA
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:BS, CADC- US
Other - Prefix:MRS
Other - First Name:TRINA
Other - Middle Name:YOLANDA
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 NW VILLAGE GREEN DR APT 320
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5993
Mailing Address - Country:US
Mailing Address - Phone:580-280-5764
Mailing Address - Fax:
Practice Address - Street 1:25 NW VILLAGE GREEN DR APT 320
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5993
Practice Address - Country:US
Practice Address - Phone:580-280-5764
Practice Address - Fax:580-280-5764
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1578088753171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator