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General NPI Number Information
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NPI Number | 1518520527
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Entity Type | Organization
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Legal Business Name | EMPOWERED WELL-BEING COUNSELING, LLC
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 4419 PHEASANT RIDGE RD STE 200
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City | ROANOKE
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State | VA
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Zip | 24014-5267
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Country | US
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Telephone | 540-315-5318
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Fax | 540-566-3320
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Provider Business Mailing Address
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Address Line | 4419 PHEASANT RIDGE RD STE 200
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City | ROANOKE
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State | VA
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Zip | 24014-5267
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Country | US
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Telephone | 540-315-5318
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Fax | 540-566-3320
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | FELICIA LANE
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Credential | LCSW
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Telephone | 540-315-5318
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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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