Healthcare Provider Details

I. General information

NPI: 1730909482
Provider Name (Legal Business Name): LDV EMPOWERMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HAMPTON HILLS DR
MOUNDVILLE AL
35474-1919
US

IV. Provider business mailing address

68 HAMPTON HILLS DR
MOUNDVILLE AL
35474-1919
US

V. Phone/Fax

Practice location:
  • Phone: 205-496-3898
  • Fax:
Mailing address:
  • Phone: 205-496-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAWANDA DENISE VANHORN-ROSSELL
Title or Position: OWNER
Credential: LICSW-S
Phone: 205-496-3898