=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679796718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIAN S SEWELL LCPC, NCC, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 N. MAIN STREET
-----------------------------------------------------
City | BOONSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-991-5973
-----------------------------------------------------
Fax | 410-848-5629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 973
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21158-0973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-848-5785
-----------------------------------------------------
Fax | 410-848-5629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------