Provider Demographics
NPI:1942542949
Name:POWELL, CHARNE BROWN (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHARNE
Middle Name:BROWN
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:CHARNE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:SCOE - PREVENTION & EARLY INTERVENTION
Mailing Address - Street 2:PO BOX 269003
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826
Mailing Address - Country:US
Mailing Address - Phone:916-217-3683
Mailing Address - Fax:
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1527
Practice Address - Country:US
Practice Address - Phone:916-217-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 74483106H00000X
CA98290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist