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General NPI Number Information
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NPI Number | 1407679251
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Entity Type | Organization
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Legal Business Name | INSPIRE. EMPOWER. CHANGE. COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 01/19/2025
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Provider Practice Location Address
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Address Line | 739 HIGH ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3425
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Country | US
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Telephone | 757-529-1575
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Fax |
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Provider Business Mailing Address
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Address Line | 739 HIGH ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3425
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Country | US
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Telephone | 757-529-1575
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR/CLINICIAN
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Name | DR. TIFFANY CRAYTON
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Credential |
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Telephone | 757-529-1575
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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