Provider Demographics
NPI:1194401802
Name:POWELL, SHEMIKAMARIE COOPER
Entity type:Individual
Prefix:MRS
First Name:SHEMIKAMARIE
Middle Name:COOPER
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 GRANARY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1434
Mailing Address - Country:US
Mailing Address - Phone:561-346-3161
Mailing Address - Fax:
Practice Address - Street 1:4005 GRANARY VIEW CT
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1434
Practice Address - Country:US
Practice Address - Phone:561-346-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0606978103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool