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General NPI Number Information
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NPI Number | 1104571702
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Entity Type | Organization
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Legal Business Name | EMPOWER AND EVOLVE COUNSELING PLLC
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 3321 WILLS GROVE LN APT 104
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City | RALEIGH
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State | NC
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Zip | 27615-8076
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Country | US
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Telephone | 919-355-8203
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Fax |
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Provider Business Mailing Address
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Address Line | 7800 FALLS OF NEUSE RD PO BOX 99181
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City | RALEIGH
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State | NC
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Zip | 27615
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Country | US
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Telephone | 919-355-8203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACLYN DITTER
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Credential | MS, LCAS, LCMHC
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Telephone | 919-355-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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