Provider Demographics
NPI:1285356295
Name:STORM-WEST, EPIC
Entity type:Individual
Prefix:
First Name:EPIC
Middle Name:
Last Name:STORM-WEST
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 NORTHLAKE MALL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0713
Mailing Address - Country:US
Mailing Address - Phone:919-903-0402
Mailing Address - Fax:
Practice Address - Street 1:6801 NORTHLAKE MALL DR STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0713
Practice Address - Country:US
Practice Address - Phone:919-238-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X, 175T00000X
101YM0800X, 101YP2500X
AR7081-19374J00000X
NCCADC-30173101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
No374J00000XNursing Service Related ProvidersDoula
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7081-19OtherMADRIELLA DOULA CERTIFICATION