Provider Demographics
NPI:1609321843
Name:MY EMPOWERING IMPACT
Entity Type:Organization
Organization Name:MY EMPOWERING IMPACT
Other - Org Name:ME IMPACT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SADE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-934-1149
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1401
Mailing Address - Country:US
Mailing Address - Phone:443-379-4545
Mailing Address - Fax:
Practice Address - Street 1:5001 HARFORD RD
Practice Address - Street 2:SUIT D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2970
Practice Address - Country:US
Practice Address - Phone:443-379-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty