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NPI Code Detail

MEDICARE: EMPOWER TO SUCCESS ENTERPRISE LLC

MEDICARE: EMPOWER TO SUCCESS ENTERPRISE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1124665641
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMPOWER TO SUCCESS ENTERPRISE LLC
Provider Business Mailing Address
First Line : 5820 E WT HARRIS BLVD STE 208
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-4032
Country : US
Telephone Number : 980-335-1972
Fax Number :
Provider Business Practice Location Address
First Line : 5820 E WT HARRIS BLVD STE 208
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-4032
Country : US
Telephone Number : 980-335-1972
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : GARY JAMAR KASEY
Credential : LCSWA
Telephone Number : 412-381-3873
Provider Enumeration Date : 12/03/2019
Last Update Date : 05/03/2021

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Directions to “EMPOWER TO SUCCESS ENTERPRISE LLC ” Practice Location

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