| Empowered Sol Wellness Center, Llc | |
|
7530 103rd St Ste 7 Jacksonville FL 32210-6786 | |
| (904) 872-2225 | |
| (406) 559-3241 |
| Full Name | Empowered Sol Wellness Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7530 103rd St Ste 7, Jacksonville, Florida |
| Authorized Official Name and Position | Terri Huston (OWNER) |
| Authorized Official Contact | 4067812314 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowered Sol Wellness Center, Llc 7530 103rd St Ste 7 Jacksonville FL 32210-6786 Ph: (904) 872-2225 | Empowered Sol Wellness Center, Llc 7530 103rd St Ste 7 Jacksonville FL 32210-6786 Ph: (904) 872-2225 |
| NPI Number | 1124689880 |
|---|---|
| Provider Enumeration Date | 06/24/2019 |
| Last Update Date | 07/07/2020 |
| Certification Date | 07/07/2020 |
| Medicare PECOS PAC ID | 6709116940 |
|---|---|
| Medicare Enrollment ID | O20191001001769 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124689880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Terri Lynn Huston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992947519 PECOS PAC ID: 6901956507 Enrollment ID: I20191001002184 |
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