Provider Demographics
NPI:1750612396
Name:POWELL COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:POWELL COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LCAS,
Authorized Official - Phone:828-429-1240
Mailing Address - Street 1:2924 FOX PL
Mailing Address - Street 2:
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114-9793
Mailing Address - Country:US
Mailing Address - Phone:828-429-1240
Mailing Address - Fax:828-657-5923
Practice Address - Street 1:2924 FOX PL
Practice Address - Street 2:
Practice Address - City:MOORESBORO
Practice Address - State:NC
Practice Address - Zip Code:28114-9793
Practice Address - Country:US
Practice Address - Phone:828-429-1240
Practice Address - Fax:828-657-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 3658261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639165012OtherNPI INDIVIDUAL
NC139VYOtherBCBS
NCE0338-B0775OtherMEDCOST
NC2246448OtherCIGNA
NC6102211Medicaid