Healthcare Provider Details

I. General information

NPI: 1407436314
Provider Name (Legal Business Name): UNIQUELY EMPOWERED COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LILAC LN
WORCESTER MA
01607-1818
US

IV. Provider business mailing address

482 SOUTHBRIDGE ST # 308
AUBURN MA
01501-2468
US

V. Phone/Fax

Practice location:
  • Phone: 413-374-1860
  • Fax:
Mailing address:
  • Phone: 413-374-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SANJAY GRANT
Title or Position: CEO/OWNER
Credential: LMHC
Phone: 413-374-1860