Provider Demographics
NPI:1801504246
Name:EMPOWERED MIND & WELLNESS
Entity type:Organization
Organization Name:EMPOWERED MIND & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EBONIQUE
Authorized Official - Middle Name:VERNEE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS DEGREE MFT
Authorized Official - Phone:229-232-9601
Mailing Address - Street 1:805 HARMON DR APT B6
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-8477
Mailing Address - Country:US
Mailing Address - Phone:229-232-9601
Mailing Address - Fax:
Practice Address - Street 1:805 HARMON DR APT B6
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-8477
Practice Address - Country:US
Practice Address - Phone:229-232-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty