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General NPI Number Information
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NPI Number | 1609598911
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Entity Type | Individual
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Provider Name | AZHANE JUNIQUE POWELL
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Gender | Female
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 3236 HOLMESTOWN RD
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-7495
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Country | US
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Telephone | 843-663-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3761 CAPE LANDING CIR APT C
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-1101
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Country | US
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Telephone | 518-375-0904
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15456
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License Number State | SC
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