Provider Demographics
NPI:1790494847
Name:INDIVIDUAL EMPOWERMENT SERVICES
Entity Type:Organization
Organization Name:INDIVIDUAL EMPOWERMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, BSN, RN
Authorized Official - Phone:703-946-7797
Mailing Address - Street 1:7915 FRYE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-1101
Mailing Address - Country:US
Mailing Address - Phone:703-946-7797
Mailing Address - Fax:
Practice Address - Street 1:7915 FRYE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1101
Practice Address - Country:US
Practice Address - Phone:703-946-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty