Provider Demographics
NPI:1730281163
Name:POWELL, JEANNIE O (LPC)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:O
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:B
Other - Last Name:OGLESBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:179 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2821
Mailing Address - Country:US
Mailing Address - Phone:488-742-1464
Mailing Address - Fax:478-742-1883
Practice Address - Street 1:179 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2821
Practice Address - Country:US
Practice Address - Phone:488-742-1464
Practice Address - Fax:478-742-1883
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA931984159AMedicaid