Provider Demographics
NPI:1114469988
Name:POWELL, MARY (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-5507
Mailing Address - Country:US
Mailing Address - Phone:540-836-3659
Mailing Address - Fax:540-434-6950
Practice Address - Street 1:71 WILSON BLVD.
Practice Address - Street 2:SUITE A01
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22939-2283
Practice Address - Country:US
Practice Address - Phone:540-836-3659
Practice Address - Fax:434-465-6950
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002531101YP2500X
VA508942101YA0400X
VA0718000040101YA0400X
VA0717000438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist