Epiphany Counseling Service

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

002489 Issued in CT

Legal business name

EPIPHANY COUNSELING SERVICE

Practice address

30 Beach Rd
Suite 3
Wolcott, CT 06716-1902

Phone

(203) 390-1468

NPI assigned

May 11, 2017

Last updated

May 11, 2017By 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

Jada I Brown, LPC

Title

Director of Clinical Services

Phone

(203) 390-1468

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1760918601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BEACH RD",
            "address_2": "SUITE 3",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067161902",
            "telephone_number": "203-390-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BEACH RD",
            "address_2": "SUITE 3",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067161902",
            "telephone_number": "203-390-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY COUNSELING SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JADA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "203-390-1468",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "002489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Wolcott, CT
• Providers in Wolcott, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.