Provider Demographics
NPI:1285256479
Name:EPPERSON, MIKI GABRIELLE (CT)
Entity type:Individual
Prefix:
First Name:MIKI
Middle Name:GABRIELLE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:GABRIELLE
Other - Last Name:EPPERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CT
Mailing Address - Street 1:12557 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12557 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9009
Practice Address - Country:US
Practice Address - Phone:440-285-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002344-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health