My Epiphany Counseling and Consultation Services, LLC.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MY EPIPHANY COUNSELING AND CONSULTATION SERVICES, LLC.

Practice address

120 Millbrook Village Dr
Tyrone, GA 30290-3605

Phone

(678) 263-8830

Fax

(678) 782-5491

NPI assigned

Jul 14, 2011

Last updated

Nov 10, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jemeka Lashay Stallworth, LPCNPI 1942455274

Title

Clinical Director/Co-Owner

Phone

(205) 919-6327

Specialties & licenses 6

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jemeka Lashay Stallworth, LPC, MSCP, CPCS, NCC

  • Mental Health Counselor
  • Tyrone, GA
  • NPI 1942455274
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1366730079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 KOHL DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537489",
            "telephone_number": "678-263-8830",
            "fax_number": "678-782-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MILLBROOK VILLAGE DR",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302903605",
            "telephone_number": "678-263-8830",
            "fax_number": "678-782-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY EPIPHANY COUNSELING AND CONSULTATION SERVICES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-14",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "STALLWORTH",
        "authorized_official_first_name": "JEMEKA",
        "authorized_official_middle_name": "LASHAY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR/CO-OWNER",
        "authorized_official_telephone_number": "205-919-6327",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "005233",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.