Provider Demographics
NPI:1710241799
Name:POWELL, LARRY DARNELL (LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DARNELL
Last Name:POWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9738 SANILAC ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1250
Mailing Address - Country:US
Mailing Address - Phone:313-320-3797
Mailing Address - Fax:
Practice Address - Street 1:9738 SANILAC ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1250
Practice Address - Country:US
Practice Address - Phone:313-320-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional