Provider Demographics
NPI:1366853095
Name:POWELL, SEAN TIMMOTHY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:TIMMOTHY
Last Name:POWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 HIBERNIA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-5531
Mailing Address - Country:US
Mailing Address - Phone:804-317-0265
Mailing Address - Fax:
Practice Address - Street 1:2007 HIBERNIA CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-5531
Practice Address - Country:US
Practice Address - Phone:804-317-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 102481041C0700X
NCC0052721041C0700X
VA09040062631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical