Provider Demographics
NPI:1407087646
Name:EMPOWERMENT FOR S.T.A.R.S, LLC
Entity Type:Organization
Organization Name:EMPOWERMENT FOR S.T.A.R.S, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MACHELLE
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-669-6283
Mailing Address - Street 1:1146 N CHURCH ST
Mailing Address - Street 2:STE A
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2702
Mailing Address - Country:US
Mailing Address - Phone:336-669-6283
Mailing Address - Fax:
Practice Address - Street 1:1146 N CHURCH ST
Practice Address - Street 2:STE A
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2702
Practice Address - Country:US
Practice Address - Phone:336-669-6283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health