Provider Demographics
NPI:1992929731
Name:EMPOWER AGENCY, LLC
Entity type:Organization
Organization Name:EMPOWER AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENITRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORBY-SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:919-636-5790
Mailing Address - Street 1:P.O. BOX 164
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-0164
Mailing Address - Country:US
Mailing Address - Phone:919-636-5790
Mailing Address - Fax:919-636-5780
Practice Address - Street 1:121 S. ESTES DR
Practice Address - Street 2:STE 104
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2868
Practice Address - Country:US
Practice Address - Phone:919-636-5790
Practice Address - Fax:919-636-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301956Medicaid