Healthcare Provider Details

I. General information

NPI: 1063343317
Provider Name (Legal Business Name): EMPOWERING GIRLS TO OVERCOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13024 WATERBOURNE DR
GIBSONTON FL
33534-3908
US

IV. Provider business mailing address

13024 WATERBOURNE DR
GIBSONTON FL
33534-3908
US

V. Phone/Fax

Practice location:
  • Phone: 813-693-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMBER ROBERTS
Title or Position: THERAPIST/MANAGER
Credential: LCSW
Phone: 813-693-1101