Provider Demographics
NPI:1508201518
Name:MIRACLES TO DESTINY
Entity Type:Organization
Organization Name:MIRACLES TO DESTINY
Other - Org Name:THELMAL EPPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EPPS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:860-436-4811
Mailing Address - Street 1:61 ARROW RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1357
Mailing Address - Country:US
Mailing Address - Phone:860-436-4811
Mailing Address - Fax:860-461-1911
Practice Address - Street 1:61 ARROW RD
Practice Address - Street 2:STE. 103
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1357
Practice Address - Country:US
Practice Address - Phone:860-436-4811
Practice Address - Fax:860-461-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00937101Y00000X, 101YA0400X
CT000937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1649574799Medicaid