Provider Demographics
NPI:1730816323
Name:EMPOWER AND EVOLVE COUNSELING
Entity type:Organization
Organization Name:EMPOWER AND EVOLVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:586-464-7432
Mailing Address - Street 1:4102 BELLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48428-9237
Mailing Address - Country:US
Mailing Address - Phone:586-464-7432
Mailing Address - Fax:
Practice Address - Street 1:4102 BELLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:MI
Practice Address - Zip Code:48428-9237
Practice Address - Country:US
Practice Address - Phone:586-464-7432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty