Provider Demographics
NPI:1811747728
Name:POWELL THERAPEUTICS, LLC
Entity type:Organization
Organization Name:POWELL THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSATP, CSAC
Authorized Official - Phone:757-254-4644
Mailing Address - Street 1:101 NEW HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5172
Mailing Address - Country:US
Mailing Address - Phone:757-254-4644
Mailing Address - Fax:804-621-7103
Practice Address - Street 1:1805 CHANTILLY ST STE 126
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3501
Practice Address - Country:US
Practice Address - Phone:757-254-4644
Practice Address - Fax:804-621-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty