Provider Demographics
NPI:1295228120
Name:EMPOWERING INNER STRENGTH, LLC
Entity Type:Organization
Organization Name:EMPOWERING INNER STRENGTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIERCKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC, CCTP-II
Authorized Official - Phone:608-630-2484
Mailing Address - Street 1:1425 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-0843
Mailing Address - Country:US
Mailing Address - Phone:715-307-2912
Mailing Address - Fax:
Practice Address - Street 1:506 MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1709
Practice Address - Country:US
Practice Address - Phone:608-630-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA14378296Medicaid
WI1295228120Medicaid