Provider Demographics
NPI:1043851306
Name:CAMPBELL POWERS, FAITH AVA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:AVA
Last Name:CAMPBELL POWERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CALLE ESCADA UNIT 90A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3684
Mailing Address - Country:US
Mailing Address - Phone:860-933-8677
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE ESCADA UNIT 90A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3684
Practice Address - Country:US
Practice Address - Phone:860-933-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist