Individual
RANDY EDWARD POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAC
Contact information
Practice address
4755 KINGSWAY DR STE 105A, INDIANAPOLIS, IN 46205-1549
(317) 803-2270
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000080A
IN
Other
Enumeration date
12/20/2017
Last updated
09/15/2021
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