Provider Demographics
NPI:1437862794
Name:POWELL, ERICA DENISE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DENISE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 PAYNE SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-0305
Mailing Address - Country:US
Mailing Address - Phone:865-369-7730
Mailing Address - Fax:
Practice Address - Street 1:1526 MEADOW SPRING DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2041
Practice Address - Country:US
Practice Address - Phone:865-262-9098
Practice Address - Fax:865-262-9103
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional