Provider Demographics
NPI:1720826456
Name:EMPOWERING MINDS EARLY INTERVENTION SERVICES LLC
Entity type:Organization
Organization Name:EMPOWERING MINDS EARLY INTERVENTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRICKET
Authorized Official - Middle Name:DIANNA
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-639-3225
Mailing Address - Street 1:1209 TISON DR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-7825
Mailing Address - Country:US
Mailing Address - Phone:843-639-3225
Mailing Address - Fax:
Practice Address - Street 1:1209 TISON DR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-7825
Practice Address - Country:US
Practice Address - Phone:843-639-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency