Provider Demographics
NPI:1750643862
Name:POWELL, DEBORAH CLARK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:CLARK
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 TRESSLE VIEW PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1374
Mailing Address - Country:US
Mailing Address - Phone:757-965-2260
Mailing Address - Fax:
Practice Address - Street 1:4329 TRESSLE VIEW PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1374
Practice Address - Country:US
Practice Address - Phone:757-285-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040079571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical