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General NPI Number Information
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NPI Number | 1396323440
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA EMPOWERMENT CLINIC PLLC
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 07/08/2023
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Provider Practice Location Address
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Address Line | 533 E GIRARD AVE # 604
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3311
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Country | US
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Telephone | 445-455-6045
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Fax | 267-762-4374
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Provider Business Mailing Address
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Address Line | 533 E GIRARD AVE # 604
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3311
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Country | US
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Telephone | 445-455-6045
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Fax | 267-762-4374
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHARLES. TYSON
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Credential | LCSW. BCD
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Telephone | 445-455-6045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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