Individual
JACKIE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAC, LISAC
Contact information
Practice address
6262 E BROADWAY RD, SUITE 101, MESA, AZ 85206-6101
(480) 664-4053
(480) 452-0883
Mailing address
6262 E BROADWAY RD, SUITE 101, MESA, AZ 85206-6101
(480) 664-4053
(480) 452-0883
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-15108
AZ
Other
Enumeration date
07/13/2016
Last updated
09/28/2018
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