Provider Demographics
NPI:1538773650
Name:POWERS, CHERYL (LGPC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 OTTERBEIN LN APT 301
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6357
Mailing Address - Country:US
Mailing Address - Phone:732-881-3422
Mailing Address - Fax:
Practice Address - Street 1:787 OELLA AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4727
Practice Address - Country:US
Practice Address - Phone:443-720-0090
Practice Address - Fax:855-212-5690
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional