MEDICARE: CREATED2EMPOWER COUNSELING SERVICES,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1821626516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATED2EMPOWER COUNSELING SERVICES,LLC

Provider Business Mailing Address
First Line	:	1001 VIRGINIA AVE STE 330
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-1367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 VIRGINIA AVE STE 330
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-1367
Country	:	US
Telephone Number	:	404-963-1838
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	CHRISTINE WHITTENBURG
Credential	:
Telephone Number	:	678-361-7991

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	03/30/2020

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