MEDICARE: MR. MARK TAYLOR POWELL LPC,M.ED.,NCC,CPRP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC005643	GA
2	101YP2500X	Professional Counselor	8113	NC

General Provider Information

NPI Number	:	1538484001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK TAYLOR POWELL LPC,M.ED.,NCC,CPRP

Provider Business Mailing Address
First Line	:	1250 WESTERN BLVD
Second Line	:	STE L-2, PMB 177
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6748
Country	:	US
Telephone Number	:	828-367-7687
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 WESTERN BLVD
Second Line	:	STE L-2, PMB 177
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6748
Country	:	US
Telephone Number	:	828-367-7687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/09/2013

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