Basic Information
| Provider Information | |||||||||
| NPI: | 1386166767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPPERSON | ||||||||
| FirstName: | TOYAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | BA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WASHINGTON | ||||||||
| OtherFirstName: | TOYAH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8212 N JENNINGS RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT MORRIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484588248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106875100 | ||||||||
| FaxNumber: | 8106870520 | ||||||||
| Practice Location | |||||||||
| Address1: | 8212 N JENNINGS RD | ||||||||
| Address2: | |||||||||
| City: | MT. MORRIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106875100 | ||||||||
| FaxNumber: | 8106870520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.