Provider Demographics
NPI:1326620477
Name:EMPOWER TO SUCCESS ENTERPRISE LLC
Entity Type:Organization
Organization Name:EMPOWER TO SUCCESS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:980-335-1972
Mailing Address - Street 1:5820 E WT HARRIS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4032
Mailing Address - Country:US
Mailing Address - Phone:980-335-1972
Mailing Address - Fax:
Practice Address - Street 1:5820 E WT HARRIS BLVD STE 208
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4032
Practice Address - Country:US
Practice Address - Phone:980-335-1972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPOWER TO SUCCESS ENTERPRISE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty