Healthcare Provider Details

I. General information

NPI: 1336716109
Provider Name (Legal Business Name): EMPOWERING MINDS RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7954 BALTIMORE ANNAPOLIS BLVD
GLEN BURNIE MD
21060-8188
US

IV. Provider business mailing address

10451 MILL RUN CIR STE 407
OWINGS MILLS MD
21117-5577
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-3670
  • Fax:
Mailing address:
  • Phone: 443-925-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

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