Provider Demographics
NPI:1184728487
Name:POWELL, CARLA B (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:B
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0645
Mailing Address - Country:US
Mailing Address - Phone:228-872-2020
Mailing Address - Fax:228-872-0226
Practice Address - Street 1:904 DE SOTO STREET
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4624
Practice Address - Country:US
Practice Address - Phone:228-872-2020
Practice Address - Fax:228-872-0226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC02661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800000033Medicare ID - Type Unspecified
R35068Medicare UPIN