Provider Demographics
NPI:1093915399
Name:SEWELL, WYNANTE AUTHRINE (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:WYNANTE
Middle Name:AUTHRINE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 OCEAN AVE
Mailing Address - Street 2:APARTMENT NO. C6
Mailing Address - City:SEA BRIGHT
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-2267
Mailing Address - Country:US
Mailing Address - Phone:717-679-7142
Mailing Address - Fax:732-383-5517
Practice Address - Street 1:946 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5304
Practice Address - Country:US
Practice Address - Phone:609-393-1626
Practice Address - Fax:609-393-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00350800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional