Provider Demographics
NPI:1639165012
Name:POWELL, JAMES EDWARD (MA,PHDLPCS/LCAS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:POWELL
Suffix:
Gender:M
Credentials:MA,PHDLPCS/LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 FOX PL
Mailing Address - Street 2:
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114-9793
Mailing Address - Country:US
Mailing Address - Phone:828-429-1240
Mailing Address - Fax:
Practice Address - Street 1:2924 FOX PL
Practice Address - Street 2:
Practice Address - City:MOORESBORO
Practice Address - State:NC
Practice Address - Zip Code:28114-9793
Practice Address - Country:US
Practice Address - Phone:828-429-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3658101YM0800X
NC1517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139VYOtherBCBS
NCE0338-B0775OtherMEDCOST
NC2246448OtherCIGNA
NC6102211Medicaid