Provider Demographics
NPI:1881288553
Name:EMPOWERED TO EVOLVE, LLC
Entity type:Organization
Organization Name:EMPOWERED TO EVOLVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:551-444-2339
Mailing Address - Street 1:1 ORIENT WAY STE F304
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2524
Mailing Address - Country:US
Mailing Address - Phone:551-444-2339
Mailing Address - Fax:
Practice Address - Street 1:1 ORIENT WAY STE F304
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2524
Practice Address - Country:US
Practice Address - Phone:551-444-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty