Provider Demographics
NPI:1871648097
Name:POWELL, LAURA ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:DATRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 521222
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-1222
Mailing Address - Country:US
Mailing Address - Phone:407-463-3500
Mailing Address - Fax:407-699-0820
Practice Address - Street 1:1991 LONGWOOD LAKE MARY RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4620
Practice Address - Country:US
Practice Address - Phone:407-463-3500
Practice Address - Fax:407-699-0820
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health