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General NPI Number Information
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NPI Number | 1750448965
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Entity Type | Individual
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Provider Name | AUGUSTUS C SEALY PHD LMHC
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 370 MAIN ST STE 910
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City | WORCESTER
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State | MA
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Zip | 01608-1723
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Country | US
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Telephone | 661-651-8596
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Fax | 661-360-9453
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Provider Business Mailing Address
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Address Line | 20000 PLUM CANYON RD UNIT 1815
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2416
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Country | US
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Telephone | 661-651-8596
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Fax | 661-360-9453
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3864
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License Number State | MA
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