1033427182 NPI number — DR. CYNTHIA ANN POWELL PSYD

Table of content: DR. CYNTHIA ANN POWELL PSYD (NPI 1033427182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033427182 NPI number — DR. CYNTHIA ANN POWELL PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033427182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 WADE AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-443-2360
Provider Business Mailing Address Fax Number:
818-861-3321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 WADE AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-443-2360
Provider Business Practice Location Address Fax Number:
818-861-3321
Provider Enumeration Date:
09/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC001393 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 4766 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC001393 . This is a "STATE LPC LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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