Provider Demographics
NPI:1255080859
Name:POWERS, CARLY (LMFT-A)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAVEN ROCK LN APT 204
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8569
Mailing Address - Country:US
Mailing Address - Phone:803-530-2706
Mailing Address - Fax:
Practice Address - Street 1:945 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2119
Practice Address - Country:US
Practice Address - Phone:864-383-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty