Healthcare Provider Details

I. General information

NPI: 1255887618
Provider Name (Legal Business Name): KAWANDA SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 LIBERTY RD
NATCHEZ MS
39120-4314
US

IV. Provider business mailing address

305 BROOKFIELD DR
NATCHEZ MS
39120-2713
US

V. Phone/Fax

Practice location:
  • Phone: 601-597-3767
  • Fax: 769-355-2337
Mailing address:
  • Phone: 601-597-3767
  • Fax: 769-355-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: