Healthcare Provider Details

I. General information

NPI: 1407186067
Provider Name (Legal Business Name): THE EMPOWERMENT ACADEMY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3781 PRESIDENTIAL PKWY SUITE 13
ATLANTA GA
30340-3702
US

IV. Provider business mailing address

3781 PRESIDENTIAL PKWY SUITE 13
ATLANTA GA
30340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 770-846-7524
  • Fax:
Mailing address:
  • Phone: 770-846-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NIKKI MACHARIA VENISEE
Title or Position: OWNER
Credential:
Phone: 770-846-7524