Basic Information
| Provider Information | |||||||||
| NPI: | 1033427182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 WADE AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194432360 | ||||||||
| FaxNumber: | 8188613321 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 WADE AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194432360 | ||||||||
| FaxNumber: | 8188613321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2010 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC001393 | PA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | 4766 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | PC001393 | 01 | PA | STATE LPC LICENSE | OTHER |