| The Empowering Space, Pllc | |
|
3083 Herschel Ave Apt 309 Dallas TX 75219-2064 | |
| (614) 592-3462 | |
| Not Available |
| Full Name | The Empowering Space, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 3083 Herschel Ave Apt 309, Dallas, Texas |
| Authorized Official Name and Position | Brittany Woodley (OWNER) |
| Authorized Official Contact | 6145923462 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Empowering Space, Pllc 3083 Herschel Ave Apt 309 Dallas TX 75219-2064 Ph: () - | The Empowering Space, Pllc 3083 Herschel Ave Apt 309 Dallas TX 75219-2064 Ph: (614) 592-3462 |
| NPI Number | 1255964177 |
|---|---|
| Provider Enumeration Date | 02/19/2020 |
| Last Update Date | 06/05/2024 |
| Certification Date | 06/05/2024 |
| Medicare PECOS PAC ID | 9830632132 |
|---|---|
| Medicare Enrollment ID | O20240614001900 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255964177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nkechi F Ezema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780192666 PECOS PAC ID: 4981931979 Enrollment ID: I20190814001540 |
| Provider Name | Melanie Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649831298 PECOS PAC ID: 5597155788 Enrollment ID: I20211202000206 |
| Provider Name | Brittany Woodley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023441516 PECOS PAC ID: 0749723047 Enrollment ID: I20240614002062 |
| Provider Name | Krystle Cumby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114592151 PECOS PAC ID: 9739622051 Enrollment ID: I20240614002402 |
| Provider Name | Brandon Willis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023697257 PECOS PAC ID: 8921541251 Enrollment ID: I20240614002705 |
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