MEDICARE: ANDREW SELL LCMHCA

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
1	101YM0800X	Mental Health Counselor	A16738
2	101YM0800X	Mental Health Counselor	A16738	NC

General Provider Information

NPI Number	:	1871166785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SELL LCMHCA

Provider Business Mailing Address
First Line	:	4315 HOULDSWORTH DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5766
Country	:	US
Telephone Number	:	240-609-8696
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 HOULDSWORTH DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5766
Country	:	US
Telephone Number	:	240-609-8696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/18/2023

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