Provider Demographics
NPI:1750189585
Name:POWELL, MARLO S (MS, LAPC, CSP)
Entity type:Individual
Prefix:
First Name:MARLO
Middle Name:S
Last Name:POWELL
Suffix:
Gender:
Credentials:MS, LAPC, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W OREGON AVE # 1141
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4197
Mailing Address - Country:US
Mailing Address - Phone:267-656-6303
Mailing Address - Fax:
Practice Address - Street 1:1911 STEEPLECHASE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8782
Practice Address - Country:US
Practice Address - Phone:267-456-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional