Provider Demographics
NPI:1780861104
Name:POWELL, LAURA TAYLOR (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:TAYLOR
Last Name:POWELL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3701
Mailing Address - Country:US
Mailing Address - Phone:803-775-7762
Mailing Address - Fax:
Practice Address - Street 1:607 CARDINAL ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3701
Practice Address - Country:US
Practice Address - Phone:803-775-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
SC30841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool