Provider Demographics
NPI:1336734680
Name:POWELL, COURTNEE LESETTE (LCSWA)
Entity Type:Individual
Prefix:
First Name:COURTNEE
Middle Name:LESETTE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 ST CROIX LN APT 310
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7457
Mailing Address - Country:US
Mailing Address - Phone:252-204-6255
Mailing Address - Fax:
Practice Address - Street 1:4020 ST CROIX LN APT 310
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7457
Practice Address - Country:US
Practice Address - Phone:252-204-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical