Provider Demographics
NPI:1619287109
Name:POWELLSON, RACHEL ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:POWELLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, RCSWI
Mailing Address - Street 1:616 A PHILIP RANDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2000
Mailing Address - Country:US
Mailing Address - Phone:904-355-0000
Mailing Address - Fax:
Practice Address - Street 1:616 A PHILIP RANDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2000
Practice Address - Country:US
Practice Address - Phone:904-355-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW176751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSOCIAL1521Medicaid