Provider Demographics
NPI:1902620594
Name:POWELL, SYDNEY CONNER CAROLINE (LCMHCA)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CONNER CAROLINE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 MARGARET MANN WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-9840
Mailing Address - Country:US
Mailing Address - Phone:336-469-7908
Mailing Address - Fax:
Practice Address - Street 1:193 LOWES DR # 102
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8603
Practice Address - Country:US
Practice Address - Phone:866-272-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health