Provider Demographics
NPI:1952350266
Name:POWELL, DONETTA PALMYRA (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:DONETTA
Middle Name:PALMYRA
Last Name:POWELL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1620 LADY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3482
Mailing Address - Country:US
Mailing Address - Phone:803-451-7600
Mailing Address - Fax:803-451-7604
Practice Address - Street 1:1620 LADY ST
Practice Address - Street 2:SUSITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3482
Practice Address - Country:US
Practice Address - Phone:803-451-7600
Practice Address - Fax:803-451-7604
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical