Provider Demographics
NPI:1104154806
Name:THE EMPOWERMENT ACADEMY FOR GIRLS AND WOMEN, INC.
Entity type:Organization
Organization Name:THE EMPOWERMENT ACADEMY FOR GIRLS AND WOMEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:MACHARIA
Authorized Official - Last Name:VENISEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-665-7935
Mailing Address - Street 1:7314 WAGON WHEEL CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2545
Mailing Address - Country:US
Mailing Address - Phone:404-665-7935
Mailing Address - Fax:
Practice Address - Street 1:7314 WAGON WHEEL CT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2545
Practice Address - Country:US
Practice Address - Phone:404-665-7935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00000001101Y00000X
GA000003252Y00000X
GA000002251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101YA0400XMedicaid
GA163W00000XMedicaid
GA171R00000XMedicaid
GA373H00000XMedicaid
GA37470000XMedicaid
GA133N00000XMedicaid
GA103K00000XMedicaid
GA101YP2500XMedicaid
GA104100000XMedicaid
GA376K00000XMedicaid
GA171M00000XMedicaid
GA374H00000XMedicaid
GA172V00000XMedicaid
GA101YM0800XMedicaid
GA167G00000XMedicaid
GA164W00000XMedicaid
GA171W00000XMedicaid
GA172A00000XMedicaid
GA174H00000XMedicaid