Provider Demographics
NPI:1710675889
Name:POWELL, TAWANNA DIANE
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:DIANE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3044
Mailing Address - Country:US
Mailing Address - Phone:240-797-9748
Mailing Address - Fax:
Practice Address - Street 1:14320 DRIFTWOOD RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3044
Practice Address - Country:US
Practice Address - Phone:240-797-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician