Organization
EMPOWERMENT CLINICAL AND CONSULTING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUDI L JACKSON (PRESIDENT)
80433787710
Entity
Organization
Contact information
Practice address
830 SOUTHLAKE BLVD STE C, RICHMOND, VA 23236-3935
(804) 330-0074
(804) 378-7715
Mailing address
830 SOUTHLAKE BLVD STE C, RICHMOND, VA 23236-3935
(804) 330-0074
(804) 378-7715
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
829
VA
101YM0800X
Mental Health Counselor
829-03-001
VA
251S00000X
Community/Behavioral Health Agency
Primary
829
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010298903
—
VA
Enumeration date
11/01/2006
Last updated
04/13/2011
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