Provider Demographics
NPI:1275905556
Name:POWELL, RACHEL MICHELLE (MSW, LCSWA, LCASA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MICHELLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW, LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5401
Mailing Address - Country:US
Mailing Address - Phone:910-224-3637
Mailing Address - Fax:910-321-3737
Practice Address - Street 1:109 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5401
Practice Address - Country:US
Practice Address - Phone:910-224-3637
Practice Address - Fax:910-321-3737
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS 22302251S00000X
NCLCSWA P009966251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health