Provider Demographics
NPI:1205340734
Name:POWELL, CHARLENE L (SAP, LCAS, CADC,)
Entity type:Individual
Prefix:MISS
First Name:CHARLENE
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:SAP, LCAS, CADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 DAN AND MARY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9085
Mailing Address - Country:US
Mailing Address - Phone:252-312-9572
Mailing Address - Fax:
Practice Address - Street 1:2409 DAN AND MARY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9085
Practice Address - Country:US
Practice Address - Phone:252-312-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20639101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)