Provider Demographics
NPI:1962226274
Name:POWELL, ERMAL GRACE KATHLEEN (LAC, DACM)
Entity type:Individual
Prefix:
First Name:ERMAL GRACE
Middle Name:KATHLEEN
Last Name:POWELL
Suffix:
Gender:
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:BOLINAS
Mailing Address - State:CA
Mailing Address - Zip Code:94924
Mailing Address - Country:US
Mailing Address - Phone:619-886-7029
Mailing Address - Fax:
Practice Address - Street 1:6040 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2181
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist