Provider Demographics
NPI:1194238014
Name:POWELL, CARLTON ALEXANDER (RBT)
Entity type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:ALEXANDER
Last Name:POWELL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:MR
Other - First Name:CARLTON
Other - Middle Name:ALEXANDER
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:197 DIVISION ST APT 10
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-1230
Mailing Address - Country:US
Mailing Address - Phone:774-208-1034
Mailing Address - Fax:
Practice Address - Street 1:197 DIVISION ST APT 10
Practice Address - Street 2:
Practice Address - City:DENNIS PORT
Practice Address - State:MA
Practice Address - Zip Code:02639-1230
Practice Address - Country:US
Practice Address - Phone:774-208-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst