| Love Empower Mentor Llc | |
|
242 Creekstone Rdg Woodstock GA 30188-3732 | |
| (678) 250-6346 | |
| Not Available |
| Full Name | Love Empower Mentor Llc |
|---|---|
| Speciality | Social Worker |
| Location | 242 Creekstone Rdg, Woodstock, Georgia |
| Authorized Official Name and Position | Olive Aneno (OWNER) |
| Authorized Official Contact | 6782506346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Love Empower Mentor Llc 531 Rendezvous Rd Acworth GA 30102-8802 Ph: (678) 250-6346 | Love Empower Mentor Llc 242 Creekstone Rdg Woodstock GA 30188-3732 Ph: (678) 250-6346 |
| NPI Number | 1619502291 |
|---|---|
| Provider Enumeration Date | 03/04/2020 |
| Last Update Date | 08/24/2022 |
| Certification Date | 08/24/2022 |
| Medicare PECOS PAC ID | 6406270180 |
|---|---|
| Medicare Enrollment ID | O20200929001131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619502291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Olive Aneno |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346699493 PECOS PAC ID: 7214351998 Enrollment ID: I20201012001428 |
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