Provider Demographics
NPI:1780278721
Name:GROW EMPOWERED, PLLC
Entity type:Organization
Organization Name:GROW EMPOWERED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:932-612-8506
Mailing Address - Street 1:6830 GETTYSBURG DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5851
Mailing Address - Country:US
Mailing Address - Phone:832-612-8506
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 408S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4384
Practice Address - Country:US
Practice Address - Phone:832-612-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty