Provider Demographics
NPI:1902423650
Name:POWELL, SHAFIK (LCSWA)
Entity Type:Individual
Prefix:MR
First Name:SHAFIK
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 LAWNDALE DR APT D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3433
Mailing Address - Country:US
Mailing Address - Phone:252-903-8305
Mailing Address - Fax:
Practice Address - Street 1:3405 W WENDOVER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1525
Practice Address - Country:US
Practice Address - Phone:336-294-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0146481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical