Provider Demographics
NPI:1932436722
Name:EMPOWERING LIVES CREATING POSSIBILITIES INC
Entity Type:Organization
Organization Name:EMPOWERING LIVES CREATING POSSIBILITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYEISHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:443-876-4091
Mailing Address - Street 1:3172 EBBTIDE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2921
Mailing Address - Country:US
Mailing Address - Phone:443-876-4091
Mailing Address - Fax:
Practice Address - Street 1:3172 EBBTIDE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2921
Practice Address - Country:US
Practice Address - Phone:443-876-4091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health