Provider Demographics
NPI:1962273326
Name:EMPOWERING YOUTH INC
Entity type:Organization
Organization Name:EMPOWERING YOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-654-7251
Mailing Address - Street 1:1031 IVES DAIRY RD STE 228
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2538
Mailing Address - Country:US
Mailing Address - Phone:305-654-7251
Mailing Address - Fax:305-640-0203
Practice Address - Street 1:901 NW 8TH AVE STE C13
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3832
Practice Address - Country:US
Practice Address - Phone:305-654-7251
Practice Address - Fax:305-647-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty