Provider Demographics
NPI:1649574799
Name:EPPS, THELMA MARIE (LADC, CAC, ICADC)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:MARIE
Last Name:EPPS
Suffix:
Gender:F
Credentials:LADC, CAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1561
Mailing Address - Country:US
Mailing Address - Phone:860-342-3252
Mailing Address - Fax:860-342-4556
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1561
Practice Address - Country:US
Practice Address - Phone:860-342-3252
Practice Address - Fax:860-342-4556
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)