Healthcare Provider Details

I. General information

NPI: 1104770866
Provider Name (Legal Business Name): EMPOWER MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 LAUREL ST # 3113
SAN DIEGO CA
92101-1605
US

IV. Provider business mailing address

236 PROVIDENCE FARM DR
BOILING SPRINGS SC
29316-7469
US

V. Phone/Fax

Practice location:
  • Phone: 951-531-3367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CASSIE CAMPBELL
Title or Position: CEO
Credential: LPCC
Phone: 951-531-3367