Provider Demographics
NPI:1396282943
Name:MAX EMPOWERMENT, LLC
Entity type:Organization
Organization Name:MAX EMPOWERMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:678-545-0498
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-0296
Mailing Address - Country:US
Mailing Address - Phone:678-545-0498
Mailing Address - Fax:
Practice Address - Street 1:217 ARROWHEAD BLVD
Practice Address - Street 2:SUITE A-4
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1169
Practice Address - Country:US
Practice Address - Phone:678-545-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004618251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health