Provider Demographics
NPI:1104063254
Name:MPOWERING KIDS MENTORING LLC
Entity type:Organization
Organization Name:MPOWERING KIDS MENTORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-618-0759
Mailing Address - Street 1:PO BOX 3229
Mailing Address - Street 2:34 E. MAIN STREET
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-3229
Mailing Address - Country:US
Mailing Address - Phone:276-634-0060
Mailing Address - Fax:276-632-2280
Practice Address - Street 1:34 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2720
Practice Address - Country:US
Practice Address - Phone:276-618-0759
Practice Address - Fax:276-638-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care