Individual
MI'TALIA SHANICE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
841 JIMMY ANN DR, DAYTONA BEACH, FL 32117-4583
(386) 425-3900
Mailing address
841 JIMMY ANN DR, DAYTONA BEACH, FL 32117-4583
(386) 425-3900
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
CBHCMP101944
FL
Other
Enumeration date
07/09/2020
Last updated
07/01/2021
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