Provider Demographics
NPI:1174752612
Name:POWERS, NITA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:J
Last Name:POWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NITA
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92650-0042
Mailing Address - Country:US
Mailing Address - Phone:949-422-1728
Mailing Address - Fax:949-552-1629
Practice Address - Street 1:13 PRIMROSE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4667
Practice Address - Country:US
Practice Address - Phone:949-422-1728
Practice Address - Fax:949-552-1629
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS245461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical