Provider Demographics
NPI:1003479411
Name:THE SISTER CIRCLE OF LOVE AND EMPOWERMENT LLC
Entity Type:Organization
Organization Name:THE SISTER CIRCLE OF LOVE AND EMPOWERMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BA/CERTIFIED LIFE COACH/EXECUTIVE D
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-896-6854
Mailing Address - Street 1:4706 BOYER GLEN DR.
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135
Mailing Address - Country:US
Mailing Address - Phone:770-896-6854
Mailing Address - Fax:
Practice Address - Street 1:4706 BOYER GLEN DR.
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:US
Practice Address - Phone:770-896-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health