Provider Demographics
NPI:1205070489
Name:POWELL, GARLANDE (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MRS
First Name:GARLANDE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 APPLETON WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7302
Mailing Address - Country:US
Mailing Address - Phone:910-317-1301
Mailing Address - Fax:
Practice Address - Street 1:2018 EASTWOOD RD STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7228
Practice Address - Country:US
Practice Address - Phone:910-344-0366
Practice Address - Fax:910-344-0301
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS1637101YA0400X
NCC0064191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007340Medicaid