Provider Demographics
NPI:1548622004
Name:EPIPHANY FAMILY SERVICES LLC
Entity type:Organization
Organization Name:EPIPHANY FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:704-236-4067
Mailing Address - Street 1:212 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4102
Mailing Address - Country:US
Mailing Address - Phone:704-236-4067
Mailing Address - Fax:803-324-0201
Practice Address - Street 1:212 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4102
Practice Address - Country:US
Practice Address - Phone:704-236-4067
Practice Address - Fax:803-324-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty