Provider Demographics
NPI:1790394815
Name:INTENTIONAL HEALING EMPOWERMENT CENTER, LLC
Entity Type:Organization
Organization Name:INTENTIONAL HEALING EMPOWERMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JOYRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-314-7768
Mailing Address - Street 1:809 N VALLEYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2448
Mailing Address - Country:US
Mailing Address - Phone:423-314-7768
Mailing Address - Fax:
Practice Address - Street 1:6727 HERITAGE BUSINESS CT STE 720
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2597
Practice Address - Country:US
Practice Address - Phone:423-314-7768
Practice Address - Fax:855-915-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty