Healthcare Provider Details

I. General information

NPI: 1922821800
Provider Name (Legal Business Name): EMPOWERMENT JOURNEY HUB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CHAMBERLAIN ST STE 1
PONTIAC MI
48342-1475
US

IV. Provider business mailing address

121 CHAMBERLAIN ST
PONTIAC MI
48342-1475
US

V. Phone/Fax

Practice location:
  • Phone: 248-678-2989
  • Fax:
Mailing address:
  • Phone: 248-678-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANTI MARIE TURNER
Title or Position: OWNER
Credential: LMSW
Phone: 248-678-2989