Healthcare Provider Details

I. General information

NPI: 1417418674
Provider Name (Legal Business Name): EMPOWERING INITIATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E OGLETHORPE AVE STE F
SAVANNAH GA
31401-4141
US

IV. Provider business mailing address

21 COVE CT
SAVANNAH GA
31419-9384
US

V. Phone/Fax

Practice location:
  • Phone: 912-208-9850
  • Fax:
Mailing address:
  • Phone: 912-695-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WES JAMES HARDCASTLE-ORR
Title or Position: OWNER/DIRECTOR
Credential: M.S.W.
Phone: 912-695-7863