Provider Demographics
NPI:1114327699
Name:POWELL, WAYNE OLIVER (LPC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:OLIVER
Last Name:POWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 BRAMBLETON AVE., S.W., SUITE 3
Mailing Address - Street 2:BRAMBLETON ASSESSMENT & COUNSELING CENTER
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3536
Mailing Address - Country:US
Mailing Address - Phone:540-537-9834
Mailing Address - Fax:540-777-5453
Practice Address - Street 1:43565 AHLEA LN
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4800
Practice Address - Country:US
Practice Address - Phone:855-326-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005499103TC1900X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling