Healthcare Provider Details

I. General information

NPI: 1164343091
Provider Name (Legal Business Name): EMPOWER CHANGE BEHAVIORAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 BERKMAR CT
CHARLOTTESVILLE VA
22901-1406
US

IV. Provider business mailing address

677 BERKMAR CT
CHARLOTTESVILLE VA
22901-1406
US

V. Phone/Fax

Practice location:
  • Phone: 434-987-1067
  • Fax:
Mailing address:
  • Phone: 434-987-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC ADDERLEY
Title or Position: CEO
Credential: LBA
Phone: 434-987-1067