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General NPI Number Information
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NPI Number | 1174328439
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Entity Type | Organization
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Legal Business Name | EMPOWERING RESILIENCE
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 48203 PRIMROSE DR
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City | MACOMB
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State | MI
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Zip | 48044-2354
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Country | US
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Telephone | 586-221-0710
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Fax |
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Provider Business Mailing Address
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Address Line | 48203 PRIMROSE DR
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City | MACOMB
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State | MI
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Zip | 48044-2354
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Country | US
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Telephone | 313-334-9042
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TAMEKIA CROOK
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Credential | PMHNP-BC
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Telephone | 313-334-9042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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