Provider Information for 1194834390
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Mrs. JACKIE DENESE POWELL M.Ed, LPC-S, LMFT
Sex: Female
NPI: 1194834390
Last Updated: 2020-08-06
Certification Date: 2020-08-06
Certification Date: 2020-08-06
Details
Name | Value | ||||||||||||||||
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NPI | 1194834390 | ||||||||||||||||
Enumeration Date | 2006-08-30 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 5154 FAULKNER DR DARROW, LA 70725-2525 United States Phone: 225-574-4752 | Fax: | ||||||||||||||||
Primary Practice Address | 1200 S ACADIAN THRUWAY BATON ROUGE, LA 70806-6900 United States Phone: 225-831-4998 | Fax:225-831-4997 | ||||||||||||||||
Secondary Practice Address(es) | 5154 FAULKNER DR 1520 THOMAS H DELPIT DR STE 125 | ||||||||||||||||
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