Provider Demographics
NPI:1962654095
Name:POWELL-LAWRENCE, DIANA (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:POWELL-LAWRENCE
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 1:11857 TRISSINO HTS
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4501
Mailing Address - Country:US
Mailing Address - Phone:719-229-9811
Mailing Address - Fax:719-599-7300
Practice Address - Street 1:1880 DUBLIN BLVD STE D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1224
Practice Address - Country:US
Practice Address - Phone:719-229-9811
Practice Address - Fax:719-599-7300
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional