Healthcare Provider Details

I. General information

NPI: 1417591405
Provider Name (Legal Business Name): EMPOWERING MIND RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 PULASKI HWY STE A
EDGEWOOD MD
21040-1654
US

IV. Provider business mailing address

500 REDLAND CT STE 213
OWINGS MILLS MD
21117-3266
US

V. Phone/Fax

Practice location:
  • Phone: 443-484-2306
  • Fax: 443-484-2970
Mailing address:
  • Phone: 410-363-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TIFFINIE CARROLL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-363-3713