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General NPI Number Information
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NPI Number | 1992292858
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Entity Type | Individual
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Provider Name | KEEANNA M POWELL LAPC
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Gender | Female
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | AGAPE TRANSFORMATION PRACTICE 235 E. PONCE DE LEON AVE SUITE 103
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City | DECATUR
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State | GA
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Zip | 30030
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Country | US
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Telephone | 678-753-5248
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Fax | 404-585-3054
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Provider Business Mailing Address
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Address Line | AGAPE TRANSFORMATION PRACTICE 235 E. PONCE DE LEON AVE SUITE 103
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City | DECATUR
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State | GA
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Zip | 30030
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Country | US
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Telephone | 678-753-5248
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Fax | 404-585-3054
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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 | APC005606
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License Number State | GA
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