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General NPI Number Information
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NPI Number | 1043851306
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Entity Type | Individual
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Provider Name | FAITH AVA CAMPBELL POWERS LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 150 CALLE ESCADA UNIT 90A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-3684
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Country | US
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Telephone | 860-933-8677
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Fax |
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Provider Business Mailing Address
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Address Line | 150 CALLE ESCADA UNIT 90A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-3684
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Country | US
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Telephone | 860-933-8677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2105
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License Number State | CT
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