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General NPI Number Information
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NPI Number | 1104154806
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Entity Type | Organization
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Legal Business Name | THE EMPOWERMENT ACADEMY FOR GIRLS AND WOMEN, INC.
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 7314 WAGON WHEEL CT
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City | JONESBORO
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State | GA
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Zip | 30236-2545
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Country | US
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Telephone | 404-665-7935
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Fax |
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Provider Business Mailing Address
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Address Line | 7314 WAGON WHEEL CT
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City | JONESBORO
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State | GA
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Zip | 30236-2545
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Country | US
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Telephone | 404-665-7935
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. NIKKI MACHARIA VENISEE
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Credential |
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Telephone | 404-665-7935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 00000001
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 000003
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 000002
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License Number State | GA
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