Provider Demographics
NPI:1053043687
Name:POWELL, JERMESHA (LCSW)
Entity Type:Individual
Prefix:
First Name:JERMESHA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JERMESHA
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8644 ROSA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6606
Mailing Address - Country:US
Mailing Address - Phone:321-945-9793
Mailing Address - Fax:
Practice Address - Street 1:8644 ROSA VISTA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6606
Practice Address - Country:US
Practice Address - Phone:321-945-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW20166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health