Healthcare Provider Details

I. General information

NPI: 1962210930
Provider Name (Legal Business Name): THE EMPOWERMENT PLACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 DAWSON ROAD STE 102
ALBANY GA
31707
US

IV. Provider business mailing address

PO BOX 491
LEESBURG GA
31763-0491
US

V. Phone/Fax

Practice location:
  • Phone: 229-329-1580
  • Fax:
Mailing address:
  • Phone: 229-329-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATERIA NICOLE ALLEN
Title or Position: OWNER/THERAPIST
Credential: M.ED., LPC, NCC
Phone: 229-329-1580