Healthcare Provider Details

I. General information

NPI: 1023579778
Provider Name (Legal Business Name): EMPOWERED LIVING COUNSELING AND LIFE COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 MOODY RD STE 105
WARNER ROBINS GA
31088-6110
US

IV. Provider business mailing address

2525 MOODY RD STE 105
WARNER ROBINS GA
31088-6110
US

V. Phone/Fax

Practice location:
  • Phone: 478-202-8947
  • Fax: 888-540-0763
Mailing address:
  • Phone: 478-202-8947
  • Fax: 888-540-0763

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TRAWICK
Title or Position: OWNER
Credential: LPC
Phone: 478-390-8408