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Organization
MY EPIPHANY COUNSELING AND CONSULTATION SERVICES, LLC.
Active
Organization
MY EPIPHANY COUNSELING AND CONSULTATION SERVICES, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEMEKA LASHAY STALLWORTH LPC (CLINICAL DIRECTOR/CO-OWNER)
(205) 919-6327
Entity
Organization
Contact information
Practice address
120 MILLBROOK VILLAGE DR, TYRONE, GA 30290-3605
(678) 263-8830
(678) 782-5491
Mailing address
809 KOHL DR, MCDONOUGH, GA 30253-7489
(678) 263-8830
(678) 782-5491
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
005233
GA
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/14/2011
Last updated
11/10/2023
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