Healthcare Provider Details

I. General information

NPI: 1275070781
Provider Name (Legal Business Name): WOMEN IN GLORY EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 01/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WALKER ST
SALISBURY NC
28144-2548
US

IV. Provider business mailing address

PO BOX 3161
SALISBURY NC
28145-3161
US

V. Phone/Fax

Practice location:
  • Phone: 704-762-6182
  • Fax:
Mailing address:
  • Phone: 704-762-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA ANN LEDBETTER
Title or Position: CEO
Credential: CPSS, QMHP
Phone: 704-762-6182