Provider Demographics
NPI:1689180515
Name:EMPOWERMENTTREATMENT & COUNSELING CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:EMPOWERMENTTREATMENT & COUNSELING CENTER FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIANESE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LPC, CEDS
Authorized Official - Phone:623-810-1663
Mailing Address - Street 1:5940 W UNION HILLS DR STE D200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1360
Mailing Address - Country:US
Mailing Address - Phone:623-810-1663
Mailing Address - Fax:
Practice Address - Street 1:5940 W UNION HILLS DR STE D200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1360
Practice Address - Country:US
Practice Address - Phone:623-810-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1114466497OtherBILLIE CHURCH
AZ1407394158OtherVALERIE FINK SIERRA
AZ1962642983OtherCARYN ATTIANESE
AZ1477080141OtherDEIDRA WOOD