Provider Demographics
NPI:1467209130
Name:POWELL, WENDY M (LMSW)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:WENDI
Other - Middle Name:M
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:122 MERCER RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-9310
Mailing Address - Country:US
Mailing Address - Phone:318-664-3088
Mailing Address - Fax:
Practice Address - Street 1:5720 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2042
Practice Address - Country:US
Practice Address - Phone:318-290-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health