Provider Demographics
NPI:1821788852
Name:WILLIAMS POWELL, CHUCKIA SHANNON
Entity Type:Individual
Prefix:
First Name:CHUCKIA
Middle Name:SHANNON
Last Name:WILLIAMS POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHUCKIA
Other - Middle Name:SHANNON
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1418 HOWARD RD SE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4460
Mailing Address - Country:US
Mailing Address - Phone:202-321-9929
Mailing Address - Fax:
Practice Address - Street 1:3300 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2408
Practice Address - Country:US
Practice Address - Phone:202-878-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health