MEDICARE: MR. LORNE JOHNNIFUL POWELL CSAC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102163	VA

General Provider Information

NPI Number	:	1679836894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LORNE JOHNNIFUL POWELL CSAC

Provider Business Mailing Address
First Line	:	4329 TRESSLE VIEW PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1374
Country	:	US
Telephone Number	:	757-618-6182
Fax Number	:

Provider Business Practice Location Address
First Line	:	4329 TRESSLE VIEW PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1374
Country	:	US
Telephone Number	:	757-618-6182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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