Provider Demographics
NPI:1104482561
Name:POWERS, ALEXIS (LCPC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11006A WOOD ELVES WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1004
Mailing Address - Country:US
Mailing Address - Phone:410-375-0002
Mailing Address - Fax:
Practice Address - Street 1:11006A WOOD ELVES WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1004
Practice Address - Country:US
Practice Address - Phone:410-375-0002
Practice Address - Fax:443-524-9395
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-11
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6698101YP2500X
MDLC13752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP6698Medicaid
MDLGP6698OtherAETNA
MDLGP6698OtherUNITED
MDLGP6698OtherCAREFIRST BLUECROSS BLUESHIELD