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NPI Code Detail

MEDICARE: MS. PENNI ACKERMAN POWELL M.S.W., L.C.S.W

MEDICARE: MS. PENNI ACKERMAN POWELL M.S.W., L.C.S.W
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
11041C0700XClinical Social WorkerC000536NC
2106H00000XMarriage & Family Therapist255NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18538AOTHERNCBLUE CROSS NC

General Provider Information

NPI Number : 1477591550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PENNI ACKERMAN POWELL M.S.W., L.C.S.W
Provider Business Mailing Address
First Line : 2012 DILWORTH RD W
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5732
Country : US
Telephone Number : 704-343-0820
Fax Number :
Provider Business Practice Location Address
First Line : 1717 CLEVELAND AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-4735
Country : US
Telephone Number : 704-372-8004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 10/29/2007

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