Provider Demographics
NPI:1215716873
Name:EMPOWERED MINDS WELLNESS CENTER
Entity type:Organization
Organization Name:EMPOWERED MINDS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKERA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW
Authorized Official - Phone:856-265-9533
Mailing Address - Street 1:27 HAMPTON GATE DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2507
Mailing Address - Country:US
Mailing Address - Phone:856-265-9533
Mailing Address - Fax:
Practice Address - Street 1:288 EGG HARBOR RD STE 9
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3131
Practice Address - Country:US
Practice Address - Phone:856-720-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty