Healthcare Provider Details

I. General information

NPI: 1356644470
Provider Name (Legal Business Name): ROBERT CHARLES POWERS M. ED. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2010
Last Update Date: 12/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

2509 LINEHAN CT
VIRGINIA BEACH VA
23454-1717
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax: 757-460-7744
Mailing address:
  • Phone: 757-404-2594
  • Fax: 757-412-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701003196
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: