Provider Demographics
NPI:1619476330
Name:POWERS, KEINETHA CAMILLE (LPC)
Entity Type:Individual
Prefix:
First Name:KEINETHA
Middle Name:CAMILLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, NCC, CPCS
Mailing Address - Street 1:5686 FULTON INDUSTRIAL BLVD SW
Mailing Address - Street 2:UNIT 44528
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-3584
Mailing Address - Country:US
Mailing Address - Phone:404-914-4782
Mailing Address - Fax:
Practice Address - Street 1:2001 MARTIN LUTHER KING JR DR SW STE 540
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1101
Practice Address - Country:US
Practice Address - Phone:888-718-2827
Practice Address - Fax:833-332-9827
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional