Provider Demographics
NPI:1528392883
Name:POWELL, CAMILLIA RAYSHAUN
Entity Type:Individual
Prefix:
First Name:CAMILLIA
Middle Name:RAYSHAUN
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 1:5450 POWER INN RD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-6749
Mailing Address - Country:US
Mailing Address - Phone:916-388-9418
Mailing Address - Fax:916-388-9273
Practice Address - Street 1:5450 POWER INN RD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-6749
Practice Address - Country:US
Practice Address - Phone:916-388-9418
Practice Address - Fax:916-388-9273
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor