Provider Demographics
NPI:1982758512
Name:POWELL, MARY PAIGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAIGE
Last Name:POWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:1208 EASTCHESTER DR
Practice Address - Street 2:STE 200
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3170
Practice Address - Country:US
Practice Address - Phone:336-802-2205
Practice Address - Fax:336-802-2206
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX32724103T00000X
NC4397103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730822-01Medicaid
NC1982758512Medicaid
NC1982758512Medicaid