Provider Demographics
NPI:1396323440
Name:PHILADELPHIA EMPOWERMENT CLINIC PLLC
Entity type:Organization
Organization Name:PHILADELPHIA EMPOWERMENT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES.
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW BCD
Authorized Official - Phone:445-455-6045
Mailing Address - Street 1:533 E GIRARD AVE # 604
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3311
Mailing Address - Country:US
Mailing Address - Phone:445-455-6045
Mailing Address - Fax:267-762-4374
Practice Address - Street 1:533 E GIRARD AVE # 604
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3311
Practice Address - Country:US
Practice Address - Phone:445-455-6045
Practice Address - Fax:267-762-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health