Provider Demographics
NPI:1902109176
Name:POWELL, BETTY (LCSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MAIN ST # 112
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3311
Mailing Address - Country:US
Mailing Address - Phone:540-315-7225
Mailing Address - Fax:484-472-1527
Practice Address - Street 1:1301 GLADEWOOD DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2612
Practice Address - Country:US
Practice Address - Phone:540-315-7225
Practice Address - Fax:484-472-1527
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0163311041C0700X
MD087871041C0700X
VA09040024921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical