Provider Demographics
NPI:1104839539
Name:POWELL, CICELY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CICELY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 ATLEE STATION RD
Mailing Address - Street 2:STE 219
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2525
Mailing Address - Country:US
Mailing Address - Phone:804-730-2829
Mailing Address - Fax:804-730-2829
Practice Address - Street 1:9097 ATLEE STATION RD
Practice Address - Street 2:STE 219
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2525
Practice Address - Country:US
Practice Address - Phone:804-730-2829
Practice Address - Fax:804-730-2829
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040034861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087536OtherSENTARA
VA102399OtherANTHEM BCBS
VA2105413OtherALLIANCE PPO
VA008951811Medicaid
VA263176000OtherMAGELLAN
VA001481C11Medicare ID - Type Unspecified