Provider Demographics
NPI:1699875641
Name:POWELL, DOROTHY E (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:E
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DOTTIE
Other - Middle Name:E
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5402 AUTUMN WOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416
Mailing Address - Country:US
Mailing Address - Phone:423-344-2316
Mailing Address - Fax:423-344-4848
Practice Address - Street 1:5721 MARLIN RD
Practice Address - Street 2:6100 BLDG STE 3200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-499-4249
Practice Address - Fax:423-499-9986
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000037661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3921115Medicaid
TN3921115Medicare ID - Type Unspecified