Provider Demographics
NPI:1962535559
Name:POWELL, DAVID (PSYD,SLP)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:PSYD,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8117
Mailing Address - Country:US
Mailing Address - Phone:757-871-1810
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-871-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003733103TC0700X, 103G00000X
VA2202003394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist