Healthcare Provider Details

I. General information

NPI: 1730762295
Provider Name (Legal Business Name): CAITLIN PAIGE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD LYNCHBURG RD
CHARLOTTESVILLE VA
22903-6500
US

IV. Provider business mailing address

8002 TERRACE GREENE CIR
BARBOURSVILLE VA
22923-2871
US

V. Phone/Fax

Practice location:
  • Phone: 434-972-1800
  • Fax:
Mailing address:
  • Phone: 540-525-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: