Basic Information
| Provider Information | |||||||||
| NPI: | 1821696626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | ELISABETH | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 REDWOOD ST NE APT A | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301614947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7622359497 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6120 ALABAMA HWY | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307362804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069356442 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2020 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CSW007331 | GA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | CSW007331 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.