Provider Demographics
NPI:1992959621
Name:POWELL, INDA S (MA)
Entity type:Individual
Prefix:MS
First Name:INDA
Middle Name:S
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA
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 44122
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-4122
Mailing Address - Country:US
Mailing Address - Phone:910-705-6711
Mailing Address - Fax:910-434-8524
Practice Address - Street 1:224 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3627
Practice Address - Country:US
Practice Address - Phone:910-705-6711
Practice Address - Fax:910-434-8524
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7222101YM0800X
SC6808101YM0800X, 101YP2500X
NCS7222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health