Individual
WILLIE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW PA
Contact information
Practice address
2115 MILLBURN AVE STE 100, MAPLEWOOD, NJ 07040-3724
(973) 763-8123
(973) 763-8243
Mailing address
2115 MILLBURN AVE STE 100, MAPLEWOOD, NJ 07040-3724
(973) 763-8123
(973) 763-8243
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
SC12965
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223167686
TAX ID
NJ
Enumeration date
01/11/2007
Last updated
11/06/2024
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