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General NPI Number Information
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NPI Number | 1205340734
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Entity Type | Individual
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Provider Name | CHARLENE L POWELL SAP, LCAS, CADC,
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Gender | Female
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 2409 DAN AND MARY ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9085
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Country | US
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Telephone | 252-312-9572
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 DAN AND MARY ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9085
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Country | US
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Telephone | 252-312-9572
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20639
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License Number State | NC
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