Provider Demographics
NPI:1174379077
Name:EMPOWERING YOU THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:EMPOWERING YOU THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-806-4109
Mailing Address - Street 1:819 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5115
Mailing Address - Country:US
Mailing Address - Phone:276-806-4109
Mailing Address - Fax:276-254-6015
Practice Address - Street 1:819 FOREST LAKE DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-5115
Practice Address - Country:US
Practice Address - Phone:276-806-4109
Practice Address - Fax:276-254-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)