Provider Demographics
NPI:1104642073
Name:POWERS, RYLEE MARIE (LGPC)
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:MARIE
Last Name:POWERS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5008
Mailing Address - Country:US
Mailing Address - Phone:667-435-6506
Mailing Address - Fax:
Practice Address - Street 1:16 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5008
Practice Address - Country:US
Practice Address - Phone:667-435-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health