Healthcare Provider Details

I. General information

NPI: 1386591600
Provider Name (Legal Business Name): MADISON POWELL MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7304 HAMPTON BLVD APT A
NORFOLK VA
23505-2924
US

IV. Provider business mailing address

1017 48TH ST APT X
NORFOLK VA
23508-1962
US

V. Phone/Fax

Practice location:
  • Phone: 757-780-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704018994
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: