Provider Demographics
NPI:1174955918
Name:EPIPHANY COUNSELING GUIDANCE AND TREATMENT SERVICES
Entity type:Organization
Organization Name:EPIPHANY COUNSELING GUIDANCE AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-788-7400
Mailing Address - Street 1:8482 HIGHWAY 85
Mailing Address - Street 2:STE A
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4308
Mailing Address - Country:US
Mailing Address - Phone:678-788-7400
Mailing Address - Fax:678-954-6896
Practice Address - Street 1:8482 HIGHWAY 85
Practice Address - Street 2:STE A
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-4308
Practice Address - Country:US
Practice Address - Phone:678-304-8677
Practice Address - Fax:678-954-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-04
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty