Provider Demographics
NPI:1033427182
Name:POWELL, CYNTHIA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 WADE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605
Mailing Address - Country:US
Mailing Address - Phone:919-443-2360
Mailing Address - Fax:818-861-3321
Practice Address - Street 1:606 WADE AVE
Practice Address - Street 2:STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605
Practice Address - Country:US
Practice Address - Phone:919-443-2360
Practice Address - Fax:818-861-3321
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001393101YP2500X
NC4766103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC001393OtherSTATE LPC LICENSE