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NPI Code Detail

MEDICARE: CAROLYN KELLY POWELL MA LCMHCA

MEDICARE:   CAROLYN KELLY POWELL  MA LCMHCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorA16862NC

General Provider Information

NPI Number : 1205504149
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN KELLY POWELL MA LCMHCA
Provider Business Mailing Address
First Line : 435 WALNUT AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-4533
Country : US
Telephone Number : 302-220-9003
Fax Number :
Provider Business Practice Location Address
First Line : 9719 NORTHEAST PKWY STE 100
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-9713
Country : US
Telephone Number : 980-999-4787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2021
Last Update Date : 09/04/2021

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Directions to “ CAROLYN KELLY POWELL MA LCMHCA” Practice Location

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