Provider Demographics
NPI:1356907745
Name:EPIPHANY COUNSELING AND CONSULTING
Entity type:Organization
Organization Name:EPIPHANY COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-740-4236
Mailing Address - Street 1:4067 BALWYNNE PARK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1601
Mailing Address - Country:US
Mailing Address - Phone:215-740-4236
Mailing Address - Fax:
Practice Address - Street 1:225 PRESIDENTIAL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1258
Practice Address - Country:US
Practice Address - Phone:215-356-4033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-12
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty