Healthcare Provider Details

I. General information

NPI: 1336748540
Provider Name (Legal Business Name): EMPOWERED WOMAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 CARLYLE AVE APT 3
MIAMI BEACH FL
33141-2072
US

IV. Provider business mailing address

2114 N FLAMINGO RD
PEMBROKE PINES FL
33028-3501
US

V. Phone/Fax

Practice location:
  • Phone: 330-705-3379
  • Fax:
Mailing address:
  • Phone: 330-705-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE EDWARDS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 330-705-3379