1114327699 NPI number — MR. WAYNE OLIVER POWELL LPC

Table of content: MR. WAYNE OLIVER POWELL LPC (NPI 1114327699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114327699 NPI number — MR. WAYNE OLIVER POWELL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
WAYNE
Provider Middle Name:
OLIVER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

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:
1114327699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3536 BRAMBLETON AVE., S.W., SUITE 3
Provider Second Line Business Mailing Address:
BRAMBLETON ASSESSMENT & COUNSELING CENTER
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-3536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-537-9834
Provider Business Mailing Address Fax Number:
540-777-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43565 AHLEA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH RIDING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20152-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-326-4673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2014

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: 103TC1900X , with the licence number:  0701005499 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 0701005499 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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