Provider Demographics
NPI:1518225259
Name:POWANDA, CHRISTINE BROWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:BROWN
Last Name:POWANDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 ANNUNCIATION ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5709
Mailing Address - Country:US
Mailing Address - Phone:504-460-4889
Mailing Address - Fax:504-392-4694
Practice Address - Street 1:1005 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8050
Practice Address - Country:US
Practice Address - Phone:504-460-4889
Practice Address - Fax:504-392-4694
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist