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General NPI Number Information
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NPI Number | 1740376409
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Entity Type | Individual
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Provider Name | JERRY DEAN POWELL D.MIN.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 916 ARSENAL AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5328
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Country | US
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Telephone | 910-309-1574
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Fax | 910-323-0310
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Provider Business Mailing Address
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Address Line | 7429 WILKINS DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-9434
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Country | US
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Telephone | 910-309-1574
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Fax | 910-323-0310
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3565
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1207
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License Number State | NC
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