Provider Demographics
NPI:1659726255
Name:POWELL, REAGAN REESE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:REAGAN
Middle Name:REESE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GOSHEN ROAD EXT STE 256
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5575
Mailing Address - Country:US
Mailing Address - Phone:912-421-1188
Mailing Address - Fax:
Practice Address - Street 1:135 GOSHEN ROAD EXT STE 256
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5575
Practice Address - Country:US
Practice Address - Phone:912-421-1000
Practice Address - Fax:912-421-1189
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional