Provider Demographics
NPI:1013315258
Name:POWELL, EMILY (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 WILLIAM HARRY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5694
Mailing Address - Country:US
Mailing Address - Phone:704-576-0832
Mailing Address - Fax:
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7372
Practice Address - Country:US
Practice Address - Phone:704-751-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health