Provider Demographics
NPI:1598417149
Name:POWELSON, DEVIN (CFO, COA)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:POWELSON
Suffix:
Gender:F
Credentials:CFO, COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 WALTHALL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-6847
Mailing Address - Country:US
Mailing Address - Phone:804-405-9217
Mailing Address - Fax:
Practice Address - Street 1:7301 FOREST AVE STE 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3792
Practice Address - Country:US
Practice Address - Phone:804-533-7272
Practice Address - Fax:804-418-3127
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588202105Medicaid