Provider Demographics
NPI:1053572065
Name:EMPOWERED TO SUCCED INC
Entity type:Organization
Organization Name:EMPOWERED TO SUCCED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-788-4511
Mailing Address - Street 1:1920 DERITA RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3355
Mailing Address - Country:US
Mailing Address - Phone:704-788-4511
Mailing Address - Fax:
Practice Address - Street 1:1920 DERITA RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3355
Practice Address - Country:US
Practice Address - Phone:704-788-4511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health