=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780562124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA FITZGERALD ATKINS POWELL LPC-A, ADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1777 BULL ST
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-2523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-814-5559
-----------------------------------------------------
Fax | 800-878-7600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4615 FOREST DR APT 422
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29206-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-634-7711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ADC-2331
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8925
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------