Healthcare Provider Details

I. General information

NPI: 1003746157
Provider Name (Legal Business Name): EMERGE EMPOWERED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 DUNBAR CT
COLUMBUS GA
31906-2633
US

IV. Provider business mailing address

1219 DUNBAR CT
COLUMBUS GA
31906-2633
US

V. Phone/Fax

Practice location:
  • Phone: 229-869-9140
  • Fax:
Mailing address:
  • Phone: 229-869-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LETASHA LANG
Title or Position: LPC
Credential: LPC
Phone: 229-869-9140