Provider Demographics
NPI:1992292858
Name:POWELL, KEEANNA M (LAPC)
Entity type:Individual
Prefix:MS
First Name:KEEANNA
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AGAPE TRANSFORMATION PRACTICE
Mailing Address - Street 2:235 E. PONCE DE LEON AVE SUITE 103
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:678-753-5248
Mailing Address - Fax:404-585-3054
Practice Address - Street 1:AGAPE TRANSFORMATION PRACTICE
Practice Address - Street 2:235 E. PONCE DE LEON AVE SUITE 103
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:678-753-5248
Practice Address - Fax:404-585-3054
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional