Provider Demographics
NPI:1609503473
Name:EPIC INTEGRATIVE HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:EPIC INTEGRATIVE HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-698-8202
Mailing Address - Street 1:6409 FAYETTEVILLE RD SUITE 120 #119
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:984-259-9359
Mailing Address - Fax:
Practice Address - Street 1:4804 PAGE CREEK LN STE 212
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8582
Practice Address - Country:US
Practice Address - Phone:984-259-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health