Provider Demographics
NPI:1104571702
Name:EMPOWER AND EVOLVE COUNSELING PLLC
Entity type:Organization
Organization Name:EMPOWER AND EVOLVE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCAS, LCMHC
Authorized Official - Phone:919-355-8203
Mailing Address - Street 1:7800 FALLS OF NEUSE RD
Mailing Address - Street 2:PO BOX 99181
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-355-8203
Mailing Address - Fax:
Practice Address - Street 1:3321 WILLS GROVE LN APT 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-8076
Practice Address - Country:US
Practice Address - Phone:919-355-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty