Healthcare Provider Details

I. General information

NPI: 1689055253
Provider Name (Legal Business Name): DENZEL SESLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 STARDUST DR
DURHAM NC
27712-9540
US

IV. Provider business mailing address

5716 STARDUST DR
DURHAM NC
27712-9540
US

V. Phone/Fax

Practice location:
  • Phone: 336-500-2403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012847
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP009604
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: