Provider Demographics
NPI:1023544178
Name:SEWELL, ANGELA (MS, ALC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 HOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-5014
Mailing Address - Country:US
Mailing Address - Phone:256-458-8819
Mailing Address - Fax:
Practice Address - Street 1:124 N 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3708
Practice Address - Country:US
Practice Address - Phone:256-458-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2832A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health