Self Healing Empowerment LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SELF HEALING EMPOWERMENT LLC

Practice address

9635 Southern Pine Blvd Ste 146
Charlotte, NC 28273-5564

Phone

(336) 749-2101

NPI assigned

Jul 24, 2018

Last updated

Oct 8, 2024By 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

Mr. Synthi'a F Penn

Title

Administrator

Phone

(336) 749-2101

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1407333248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9635 SOUTHERN PINE BLVD STE 146",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282735564",
            "telephone_number": "336-257-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9635 SOUTHERN PINE BLVD STE 146",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282735564",
            "telephone_number": "336-749-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF HEALING EMPOWERMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "PENN",
        "authorized_official_first_name": "SYNTHI'A",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-749-2101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "preciousangelsyn@embarqmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1110 E Brewington Rd",
            "city": "Sumter",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291538963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.