Healthcare Provider Details

I. General information

NPI: 1649402389
Provider Name (Legal Business Name): ANNA R POWE NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 WEEPING WILLOW CIR
HATTIESBURG MS
39402-6087
US

IV. Provider business mailing address

2322 WEEPING WILLOW CIR
HATTIESBURG MS
39402-6087
US

V. Phone/Fax

Practice location:
  • Phone: 601-705-1901
  • Fax:
Mailing address:
  • Phone: 601-705-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number225571
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: