Provider Demographics
NPI:1356562581
Name:EPPS, TERIQUE ANTOINE (QMRP,QDDP,QMHP)
Entity type:Individual
Prefix:MR
First Name:TERIQUE
Middle Name:ANTOINE
Last Name:EPPS
Suffix:
Gender:M
Credentials:QMRP,QDDP,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8712 RIVER KEEPER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616
Mailing Address - Country:US
Mailing Address - Phone:919-609-8686
Mailing Address - Fax:919-790-9755
Practice Address - Street 1:1127 CEDAR HURST DR. SUITE 270
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5487
Practice Address - Country:US
Practice Address - Phone:919-790-7775
Practice Address - Fax:919-790-9755
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management