Provider Demographics
NPI:1144771775
Name:POWELL, LINCOLN JR
Entity Type:Individual
Prefix:MR
First Name:LINCOLN
Middle Name:
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-3201
Mailing Address - Country:US
Mailing Address - Phone:225-394-2043
Mailing Address - Fax:
Practice Address - Street 1:114 MORGAN ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2576
Practice Address - Country:US
Practice Address - Phone:225-394-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator