Healthcare Provider Details

I. General information

NPI: 1518615087
Provider Name (Legal Business Name): KATHLEEN NOEL SEWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SUGARLOAF CIR STE 575
DULUTH GA
30097-9804
US

IV. Provider business mailing address

961 NORTHSIDE DR
LAWRENCEVILLE GA
30043-4564
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-7971
  • Fax:
Mailing address:
  • Phone: 404-274-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC008174
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC008174
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014993
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: