Organization
EMPOWERMENT CLINICAL & CONSULTING SERVICES OF FREDERICKSBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUDI JACKSON (PRESIDENT)
(804) 378-7710
Entity
Organization
Contact information
Practice address
307 LAFAYETTE BLVD, FREDERICKSBURG, VA 22401-6066
(540) 903-3487
Mailing address
830 SOUTHLAKE BLVD STE C, RICHMOND, VA 23236-3935
(804) 378-7710
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
829
VA
101YM0800X
Mental Health Counselor
Primary
829-05-001
VA
251S00000X
Community/Behavioral Health Agency
829-05-001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194954008
—
VA
Enumeration date
07/13/2009
Last updated
04/08/2011
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