Provider Demographics
NPI:1225395924
Name:POWELL, DAMON ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:ANTHONY
Last Name:POWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3204
Mailing Address - Country:US
Mailing Address - Phone:510-663-7954
Mailing Address - Fax:510-663-7980
Practice Address - Street 1:1320 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3204
Practice Address - Country:US
Practice Address - Phone:510-663-7954
Practice Address - Fax:510-663-7980
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker