Provider Demographics
NPI:1760918601
Name:EPIPHANY COUNSELING SERVICE
Entity Type:Organization
Organization Name:EPIPHANY COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JADA
Authorized Official - Middle Name:I
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-390-1468
Mailing Address - Street 1:30 BEACH RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-1902
Mailing Address - Country:US
Mailing Address - Phone:203-390-1468
Mailing Address - Fax:
Practice Address - Street 1:30 BEACH RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-1902
Practice Address - Country:US
Practice Address - Phone:203-390-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty