Healthcare Provider Details

I. General information

NPI: 1154606267
Provider Name (Legal Business Name): EDWIN WITT POWELL PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PEDIATRICS 2041 GEORGIA AVE, NW
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

1754 VERBENA ST NW
WASHINGTON DC
20012-1049
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-4541
  • Fax:
Mailing address:
  • Phone: 202-882-9655
  • Fax: 202-249-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberNA
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14017
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: