Healthcare Provider Details

I. General information

NPI: 1689740904
Provider Name (Legal Business Name): AMY FELICE SELLERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC ATTN MCXW QM
REDSTONE ARSENAL AL
35809
US

IV. Provider business mailing address

7584 OLD MADISON PIKE NW #214
HUNTSVILLE AL
35806-4505
US

V. Phone/Fax

Practice location:
  • Phone: 703-365-0788
  • Fax:
Mailing address:
  • Phone: 706-575-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: