Provider Demographics
NPI:1700877503
Name:POWERS, DENISE CAROL (LCSW)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:CAROL
Last Name:POWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CENTRAL PLZ # 415
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3233
Mailing Address - Country:US
Mailing Address - Phone:706-509-5040
Mailing Address - Fax:
Practice Address - Street 1:255 W 5TH ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2817
Practice Address - Country:US
Practice Address - Phone:706-509-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBCBGMedicare ID - Type UnspecifiedPROVIDER NUMBER