Provider Demographics
NPI:1760013726
Name:EMPOWERMENT COUNSELING RESOURCE GROUP LLP
Entity Type:Organization
Organization Name:EMPOWERMENT COUNSELING RESOURCE GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-256-1960
Mailing Address - Street 1:3195 OLD WASHINGTON RD STE 225
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3201
Mailing Address - Country:US
Mailing Address - Phone:301-256-1960
Mailing Address - Fax:
Practice Address - Street 1:3195 OLD WASHINGTON RD STE 225
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3201
Practice Address - Country:US
Practice Address - Phone:301-256-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health