Healthcare Provider Details

I. General information

NPI: 1225263239
Provider Name (Legal Business Name): DONNA N. SEWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 TH MEDICAL GROUP SGHC 30 NIGHTINGALE ROAD
EDWARDS AFB CA
93524-1730
US

IV. Provider business mailing address

1016 GARRETT DRIVE
BIRMINGHAM AL
35235
US

V. Phone/Fax

Practice location:
  • Phone: 404-245-1344
  • Fax:
Mailing address:
  • Phone: 404-245-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003818
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: