Provider Demographics
NPI:1639356199
Name:EMPOWERED TO SUCCEED, INC.
Entity Type:Organization
Organization Name:EMPOWERED TO SUCCEED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-253-4434
Mailing Address - Street 1:352 W HARDEN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-7516
Mailing Address - Country:US
Mailing Address - Phone:980-253-4434
Mailing Address - Fax:
Practice Address - Street 1:352 W HARDEN ST
Practice Address - Street 2:SUITE C
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-7516
Practice Address - Country:US
Practice Address - Phone:980-253-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health