MEDICARE: AUNDRA POWELL CAC11087

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	101Y00000X	Counselor	CAC11087	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568109619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUNDRA POWELL CAC11087

Provider Business Mailing Address
First Line	:	1516 OLIVE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-2715
Country	:	US
Telephone Number	:	202-276-0542
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 WEST AVE
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2746
Country	:	US
Telephone Number	:	202-276-0542
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	01/23/2026

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