Healthcare Provider Details

I. General information

NPI: 1518862630
Provider Name (Legal Business Name): EMPOWERED WELLNESS COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MARKET ST STE 302
HAVRE DE GRACE MD
21078-3280
US

IV. Provider business mailing address

203 MARKET ST STE 302
HAVRE DE GRACE MD
21078-3280
US

V. Phone/Fax

Practice location:
  • Phone: 443-987-6498
  • Fax:
Mailing address:
  • Phone: 443-987-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIE MIZAK
Title or Position: OWNER/ THERAPIST
Credential: LCSW-C
Phone: 732-690-7435