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General NPI Number Information
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NPI Number | 1679896815
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Entity Type | Organization
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Legal Business Name | MELISSA A. POWELL LCSW, LLC
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 12/05/2010
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Provider Practice Location Address
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Address Line | 5700 OLD RICHMOND AVE SUITE G-30
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City | RICHMOND
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State | VA
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Zip | 23226-1828
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Country | US
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Telephone | 804-363-4334
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Fax | 804-288-0705
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Provider Business Mailing Address
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Address Line | 5700 OLD RICHMOND AVE SUITE G-30
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City | RICHMOND
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State | VA
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Zip | 23226-1828
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Country | US
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Telephone | 804-363-4334
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Fax | 804-288-0705
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. MELISSA A POWELL
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Credential | LCSW
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Telephone | 804-363-4334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007298
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License Number State | VA
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