Healthcare Provider Details

I. General information

NPI: 1669376489
Provider Name (Legal Business Name): EMPOWERED WALKS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17804 BLACKFORD BURN CT
LUTZ FL
33559-3966
US

IV. Provider business mailing address

17804 BLACKFORD BURN CT
LUTZ FL
33559-3966
US

V. Phone/Fax

Practice location:
  • Phone: 813-758-2725
  • Fax:
Mailing address:
  • Phone: 813-758-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AYANA LATOYA LUCAS
Title or Position: CEO
Credential:
Phone: 813-758-2725