Provider Demographics
NPI:1255525812
Name:POWERS, FAITH M (CSW)
Entity type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:M
Last Name:POWERS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MISS
Other - First Name:FAITH
Other - Middle Name:MARIE
Other - Last Name:BOWDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:2311 FORTUNE DR
Practice Address - Street 2:STU 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4264
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid