Individual
BENNY LEE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDIV, LCAC
Contact information
Practice address
2100 GOSHEN RD, FORT WAYNE, IN 46808-1493
(240) 471-3500
(260) 471-4263
Mailing address
850 N HARRISON ST, ATTN: ANNE LAWSON - CREDENTIALING, WARSAW, IN 46580-3163
(574) 267-7169
(574) 269-0597
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000082A
IN
Other
Enumeration date
06/03/2009
Last updated
10/26/2010
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