Provider Demographics
NPI:1962042812
Name:BE EPIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BE EPIC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEQUILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-886-3694
Mailing Address - Street 1:323 PINE AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2575
Mailing Address - Country:US
Mailing Address - Phone:229-886-3694
Mailing Address - Fax:866-208-0960
Practice Address - Street 1:323 PINE AVE STE 114
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2575
Practice Address - Country:US
Practice Address - Phone:229-886-3694
Practice Address - Fax:866-208-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty