Provider Demographics
NPI:1417591405
Name:EMPOWERING MIND RESOURCE CENTER
Entity Type:Organization
Organization Name:EMPOWERING MIND RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFINIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-363-3713
Mailing Address - Street 1:500 REDLAND CT STE 213
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3266
Mailing Address - Country:US
Mailing Address - Phone:410-363-3713
Mailing Address - Fax:
Practice Address - Street 1:1833 PULASKI HWY STE A
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1654
Practice Address - Country:US
Practice Address - Phone:443-484-2306
Practice Address - Fax:443-484-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)