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
101YP2500X
Professional Counselor
—
—
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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