Provider Demographics
NPI:1548775273
Name:EMBRACE TO EMPOWER WELLNESS CENTER
Entity type:Organization
Organization Name:EMBRACE TO EMPOWER WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:LATAMIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITE-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-937-5599
Mailing Address - Street 1:4720 CLEVELAND HEIGHTS BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2246
Mailing Address - Country:US
Mailing Address - Phone:863-937-5599
Mailing Address - Fax:863-816-5403
Practice Address - Street 1:4720 CLEVELAND HEIGHTS BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2246
Practice Address - Country:US
Practice Address - Phone:863-937-5599
Practice Address - Fax:863-816-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty