Provider Demographics
NPI:1306392709
Name:DUO EMPOWERMENT SERVICES
Entity Type:Organization
Organization Name:DUO EMPOWERMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL PROVIDER
Authorized Official - Prefix:PROF
Authorized Official - First Name:NAKAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT-BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC
Authorized Official - Phone:323-977-8570
Mailing Address - Street 1:650 N GIRLS SCHOOL RD
Mailing Address - Street 2:SUITE C30
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3672
Mailing Address - Country:US
Mailing Address - Phone:323-977-8570
Mailing Address - Fax:317-245-4096
Practice Address - Street 1:650 N GIRLS SCHOOL RD
Practice Address - Street 2:SUITE C30
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3672
Practice Address - Country:US
Practice Address - Phone:323-977-8570
Practice Address - Fax:317-245-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006733A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health