Healthcare Provider Details

I. General information

NPI: 1003771908
Provider Name (Legal Business Name): THE EMPOWERED WELLNESS PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 HARTFORD AVE STE 4
JOHNSTON RI
02919-3268
US

IV. Provider business mailing address

1665 HARTFORD AVE UNIT BOX 4
JOHNSTON RI
02919-3200
US

V. Phone/Fax

Practice location:
  • Phone: 401-237-0131
  • Fax:
Mailing address:
  • Phone: 401-237-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NI'COLE J WHALEN
Title or Position: FOUNDER & EXECUTIVE DIRECTOR
Credential:
Phone: 401-237-0131