Healthcare Provider Details

I. General information

NPI: 1790494847
Provider Name (Legal Business Name): INDIVIDUAL EMPOWERMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 FRYE RD
ALEXANDRIA VA
22309-1101
US

IV. Provider business mailing address

7915 FRYE RD
ALEXANDRIA VA
22309-1101
US

V. Phone/Fax

Practice location:
  • Phone: 703-946-7797
  • Fax:
Mailing address:
  • Phone: 703-946-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SIA SUMANA
Title or Position: OWNER
Credential: MSN, BSN, RN
Phone: 703-946-7797