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General NPI Number Information
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NPI Number | 1649357161
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Entity Type | Organization
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Legal Business Name | EMPOWERMENT CLINICAL AND CONSULTING SERVICES
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 830 SOUTHLAKE BLVD STE C
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City | RICHMOND
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State | VA
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Zip | 23236-3935
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Country | US
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Telephone | 804-330-0074
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Fax | 804-378-7715
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Provider Business Mailing Address
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Address Line | 830 SOUTHLAKE BLVD STE C
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City | RICHMOND
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State | VA
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Zip | 23236-3935
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Country | US
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Telephone | 804-330-0074
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Fax | 804-378-7715
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RUDI L JACKSON
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Credential |
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Telephone | 80433787710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 829
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 829-03-001
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 829
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License Number State | VA
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