=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548324833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SOCIAL EMPOWERMENT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2775 CRUSE RD STE 901
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-7143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-925-2095
-----------------------------------------------------
Fax | 866-468-1886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2775 CRUSE RD STE 901
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-7143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-925-2095
-----------------------------------------------------
Fax | 866-468-1886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. RACHELLE DINET HUTCHINSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 770-925-2095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW003550
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------