Jerry Dean Powell, D.MIN.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3565 Issued in NC

Practice address

916 Arsenal Ave
Fayetteville, NC 28305-5328

Phone

(910) 309-1574

Fax

(910) 323-0310

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1740376409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7429 WILKINS DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283119434",
            "telephone_number": "910-309-1574",
            "fax_number": "910-323-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 ARSENAL AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055328",
            "telephone_number": "910-309-1574",
            "fax_number": "910-323-0310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "JERRY",
        "middle_name": "DEAN",
        "credential": "D.MIN.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3565",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "1207",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "199121",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103661",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Powell-Blackwell
• Albert Jonathan Powell
• Billy Powell Jr.
• Cache Powell
• Erica Powell, LCSW
• Kiersten Powell
• Mark Bradley Powell, DPT
• Michelle Vice Powell, PA-C
• Omar Abdu Powell, RRT/SDS/RPSGT
• Rachel Michelle Powell, MSW, LCSWA, LCASA

• All providers in Fayetteville, NC
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.