Empowerment Clinical & Consulting Services of Fredericksburg

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

829-05-001 Issued in VA

Legal business name

EMPOWERMENT CLINICAL & CONSULTING SERVICES OF FREDERICKSBURG

Practice address

307 Lafayette Blvd
Fredericksburg, VA 22401-6066

Phone

(540) 903-3487

NPI assigned

Jul 13, 2009

Last updated

Apr 8, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rudi Jackson

Title

President

Phone

(804) 378-7710

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302220800000",
    "number": "1194954008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 SOUTHLAKE BLVD STE C",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232363935",
            "telephone_number": "804-378-7710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 LAFAYETTE BLVD",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224016066",
            "telephone_number": "540-903-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERMENT CLINICAL & CONSULTING SERVICES OF FREDERICKSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2011-04-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RUDI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-378-7710"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "829",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "829-05-001",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "829-05-001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194954008",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.