Provider Demographics
NPI:1760798466
Name:S. J. POWELL, LLC
Entity Type:Organization
Organization Name:S. J. POWELL, LLC
Other - Org Name:SARA J. POWELL, LMSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-239-8985
Mailing Address - Street 1:42469 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1651
Mailing Address - Country:US
Mailing Address - Phone:586-239-8985
Mailing Address - Fax:586-477-4781
Practice Address - Street 1:42469 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1651
Practice Address - Country:US
Practice Address - Phone:586-239-8985
Practice Address - Fax:586-477-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010881701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty