Provider Demographics
NPI:1841546744
Name:POWELL, SHANNA BREEAHN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:BREEAHN
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:BREEAHN
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1153 STAMPER ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303
Mailing Address - Country:US
Mailing Address - Phone:910-990-7668
Mailing Address - Fax:
Practice Address - Street 1:450 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-1084
Practice Address - Country:US
Practice Address - Phone:800-913-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0112101041C0700X
NCP1010851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical