Healthcare Provider Details

I. General information

NPI: 1851090112
Provider Name (Legal Business Name): EMPOWER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 BARNWOOD DR
CLINTON MD
20735-2298
US

IV. Provider business mailing address

6307 BARNWOOD DR
CLINTON MD
20735-2298
US

V. Phone/Fax

Practice location:
  • Phone: 301-526-4159
  • Fax:
Mailing address:
  • Phone: 301-526-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHARITA JOHNSON
Title or Position: OWNER
Credential:
Phone: 202-526-4159