Provider Demographics
NPI:1760814016
Name:POWELL, TRACI DENISE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:DENISE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 OAK LEAF DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1318
Mailing Address - Country:US
Mailing Address - Phone:301-593-4286
Mailing Address - Fax:301-593-6648
Practice Address - Street 1:11235 OAK LEAF DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1318
Practice Address - Country:US
Practice Address - Phone:301-593-4286
Practice Address - Fax:301-593-6648
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126691041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool