MEDICARE: CAROLINA DACCARETT POWELL LICSW /LCSW

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	1041C0700X	Clinical Social Worker	0904006568	VA

General Provider Information

NPI Number	:	1871670380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA DACCARETT POWELL LICSW /LCSW

Provider Business Mailing Address
First Line	:	104 DURRINGTON PL
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23236-3257
Country	:	US
Telephone Number	:	804-893-3078
Fax Number	:	804-893-3078

Provider Business Practice Location Address
First Line	:	3002 HUNGARY SPRING RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2425
Country	:	US
Telephone Number	:	804-755-4545
Fax Number	:	804-893-3078

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/13/2008

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