MEDICARE: EMPOWERED TO THRIVE COUNSELING AND WELLNESS, 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1841769890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED TO THRIVE COUNSELING AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	221 RUTHERS RD STE 102
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-396-4678
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 RUTHERS RD STE 102
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-396-4678
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE MCLAUGHLIN
Credential	:	LCSW
Telephone Number	:	804-516-4891

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	06/30/2020

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