Doctor Name: | KNJAADO POWELL |
NPI Number: | 1306202114 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 6868 W Kingston Dr Mccordsville, IN - 460559221 |
Business Phone Number: | 3175884153 |
Business Fax Number: | |
Mailing Address: | 6868 W Kingston Dr, MCCORDSVILLE |
State: | IN |
Postal Code: | 460559221 |
Phone Number: | 3175884153 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2016 |
NPI Last Update Date: | 01/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |