Provider Demographics
NPI:1013584515
Name:TRANSFORMATION COLLABORATIVE EMPOWERMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:TRANSFORMATION COLLABORATIVE EMPOWERMENT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TANEKA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:336-255-4394
Mailing Address - Street 1:6329 UNITY ST STE D
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-7186
Mailing Address - Country:US
Mailing Address - Phone:336-255-4394
Mailing Address - Fax:419-754-2534
Practice Address - Street 1:6329 UNITY ST STE D
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-7186
Practice Address - Country:US
Practice Address - Phone:336-255-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1780187518Medicaid