Healthcare Provider Details

I. General information

NPI: 1114864923
Provider Name (Legal Business Name): JEFFREY DAVID POWELL CADC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 E PALMDALE BLVD
PALMDALE CA
93550-4745
US

IV. Provider business mailing address

1128 E AVENUE J
LANCASTER CA
93535-3957
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax:
Mailing address:
  • Phone: 661-604-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: