MEDICARE: ADAM POWELL

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	101YM0800X	Mental Health Counselor	LPC012527	GA

General Provider Information

NPI Number	:	1700514171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM POWELL

Provider Business Mailing Address
First Line	:	232 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7834
Country	:	US
Telephone Number	:	770-282-7116
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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Directions to “ ADAM POWELL ” Practice Location

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