Provider Demographics
NPI:1518520527
Name:EMPOWERED WELL-BEING COUNSELING, LLC
Entity type:Organization
Organization Name:EMPOWERED WELL-BEING COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-315-5318
Mailing Address - Street 1:4419 PHEASANT RIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5267
Mailing Address - Country:US
Mailing Address - Phone:540-315-5318
Mailing Address - Fax:540-566-3320
Practice Address - Street 1:4419 PHEASANT RIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5267
Practice Address - Country:US
Practice Address - Phone:540-315-5318
Practice Address - Fax:540-566-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0004945221Medicaid