1811358070 NPI number — EMPOWERING YOU COUNSELING SERVICES, LLC

Table of content: (NPI 1811358070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811358070 NPI number — EMPOWERING YOU COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPOWERING YOU COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811358070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2969 SUMMIT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30236-6252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-378-8655
Provider Business Mailing Address Fax Number:
770-703-5676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 S MCDONOUGH ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-3668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-378-8655
Provider Business Practice Location Address Fax Number:
770-703-5676
Provider Enumeration Date:
03/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BENEFIELD
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-378-8655

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  LPC006186 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003179259A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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