Provider Demographics
NPI:1538484001
Name:POWELL, MARK TAYLOR (LPC,MED,NCC,CPRP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:TAYLOR
Last Name:POWELL
Suffix:
Gender:M
Credentials:LPC,MED,NCC,CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WESTERN BLVD
Mailing Address - Street 2:STE L-2, PMB 177
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6748
Mailing Address - Country:US
Mailing Address - Phone:828-367-7687
Mailing Address - Fax:
Practice Address - Street 1:1250 WESTERN BLVD
Practice Address - Street 2:STE L-2, PMB 177
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6748
Practice Address - Country:US
Practice Address - Phone:828-367-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005643101YP2500X
NC8113101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional