Provider Demographics
NPI:1811580970
Name:POWDERLY, CARLA JEANETTE (LPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEANETTE
Last Name:POWDERLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 EAGLES HILL RDG
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6483
Mailing Address - Country:US
Mailing Address - Phone:636-699-0459
Mailing Address - Fax:
Practice Address - Street 1:5988 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-7119
Practice Address - Country:US
Practice Address - Phone:314-328-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019009034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health