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General NPI Number Information
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NPI Number | 1023124229
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Entity Type | Individual
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Provider Name | WALTER JACKSON SELLERS MA
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 804 S GARNETT ST
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City | HENDERSON
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State | NC
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Zip | 27536
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Country | US
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Telephone | 252-430-7442
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SEDGEWOOD RD
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City | CHAPEL HILL
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State | NC
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Zip | 27514
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Country | US
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Telephone | 919-942-8445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 401
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License Number State | NC
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