Provider Demographics
NPI:1669894135
Name:POWERS, CLARENCE (LCAS)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CRAVEN ST
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:NC
Mailing Address - Zip Code:27209-9521
Mailing Address - Country:US
Mailing Address - Phone:910-571-2992
Mailing Address - Fax:
Practice Address - Street 1:106 CRAVEN ST
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9521
Practice Address - Country:US
Practice Address - Phone:910-571-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health