Powell, Jerry Dean

Powell, Jerry Dean is an sole proprietor health care provider with primary practice located at 916 Arsenal Ave , Fayetteville NC 28305-5328. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Powell, Jerry Dean can be contacted via phone (910) 309-1574.

Contact Information

Primary practice address
916 Arsenal Ave Fayetteville NC 28305-5328
Phone: (910) 309-1574
Fax: (910) 323-0310
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 3565 North Carolina
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 1207 North Carolina

Profile Details

NPI number 1740376409
LBN Legal business name Powell, Jerry Dean
Credentials D.MIN.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2006
Last updated Jun 15th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740376409 NPPES
North Carolina Other 199121 MEDCOST
North Carolina MEDICAID 6103661 MEDCOST

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