Provider Demographics
NPI:1992856983
Name:POWELL, MICHELLE FRANKLIN (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FRANKLIN
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 WOODHILL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8317
Mailing Address - Country:US
Mailing Address - Phone:704-239-2144
Mailing Address - Fax:
Practice Address - Street 1:5855 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8883
Practice Address - Country:US
Practice Address - Phone:704-537-1202
Practice Address - Fax:704-537-1209
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102474Medicaid
NC017EJOtherBLUE CROSS BLUE SHIELD
NC6106468Medicaid