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General NPI Number Information
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NPI Number | 1619446994
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Entity Type | Organization
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Legal Business Name | FREE CLINIC OF POWHATAN
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 2320 SKAGGS RD
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City | POWHATAN
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State | VA
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Zip | 23139-5713
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Country | US
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Telephone | 804-598-5637
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Fax | 804-598-5636
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Provider Business Mailing Address
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Address Line | 2320 SKAGGS RD
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City | POWHATAN
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State | VA
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Zip | 23139-5713
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Country | US
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Telephone | 804-598-5637
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Fax | 804-598-5636
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ELIZABETH REAM
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Credential |
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Telephone | 804-598-5637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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