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NPI Code Detail

MEDICARE: REBECCA MAE SEWELL LP

MEDICARE: REBECCA MAE SEWELL LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6570NC
2103TC0700XClinical PsychologistP08081OH
3103T00000XPsychologist6570NC

General Provider Information

NPI Number : 1053867051
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA MAE SEWELL LP
Provider Business Mailing Address
First Line : 15801 BRIXHAM HILL AVE STE 475
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-0878
Country : US
Telephone Number : 704-251-9084
Fax Number :
Provider Business Practice Location Address
First Line : 15801 BRIXHAM HILL AVE STE 475
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-0878
Country : US
Telephone Number : 704-251-9084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2016
Last Update Date : 07/30/2024

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Directions to “ REBECCA MAE SEWELL LP” Practice Location

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