Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3101 | NC |
Y | 103T00000X | Psychologist | 3101 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3101 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3101 | NC |
N | 103TH0100X | Health Service | 3101 | NC |
NPI | 1225014723 |
---|---|
Provider Name | Dr. Jenifer L Powell |
First Address | Raleigh, NC 27610-1247 |
Second Address | Raleigh, NC 27610-1231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 11/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046PP | BCBS NC (01) | NC |
6000751 | (05) | NC |
6000856 | (05) | NC |