Provider Demographics
NPI:1124787882
Name:POWELL, JAMAAL JAMES (SOCIAL WORKER, LCSW)
Entity type:Individual
Prefix:
First Name:JAMAAL
Middle Name:JAMES
Last Name:POWELL
Suffix:
Gender:M
Credentials:SOCIAL WORKER, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 WORRALL WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1833
Mailing Address - Country:US
Mailing Address - Phone:904-407-5619
Mailing Address - Fax:
Practice Address - Street 1:4715 WORRALL WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1833
Practice Address - Country:US
Practice Address - Phone:904-407-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW190101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical