Provider Demographics
NPI:1477729655
Name:POWELL, ANTHONY EUGENE (LPC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EUGENE
Last Name:POWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SMOKETREE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4217
Mailing Address - Country:US
Mailing Address - Phone:434-258-9126
Mailing Address - Fax:
Practice Address - Street 1:1409 OLD DOMINION BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3285
Practice Address - Country:US
Practice Address - Phone:540-586-5429
Practice Address - Fax:540-586-1481
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004250101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health