Provider Demographics
NPI:1710475959
Name:EPIPHANY FAMILY SERVICES- MARYLAND LLC
Entity Type:Organization
Organization Name:EPIPHANY FAMILY SERVICES- MARYLAND LLC
Other - Org Name:NEXT STEP TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTREET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LCADC
Authorized Official - Phone:443-873-7193
Mailing Address - Street 1:3301 BELAIR RD
Mailing Address - Street 2:2ND FLOOR SUITE 2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1257
Mailing Address - Country:US
Mailing Address - Phone:443-873-7193
Mailing Address - Fax:410-630-7882
Practice Address - Street 1:3301 BELAIR RD
Practice Address - Street 2:2ND FLOOR SUITE 2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1257
Practice Address - Country:US
Practice Address - Phone:410-873-7193
Practice Address - Fax:410-630-7882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPIPHANY FAMILY SERVICES- MARYLAND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBH000613251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health