Provider Demographics
NPI:1285825596
Name:LOVE, SEVILLA INGERSOLL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SEVILLA
Middle Name:INGERSOLL
Last Name:LOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SEVILLA
Other - Middle Name:LYNN
Other - Last Name:INGERSOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6501 TESHLAR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2218
Mailing Address - Country:US
Mailing Address - Phone:907-887-6269
Mailing Address - Fax:907-887-6269
Practice Address - Street 1:6501 TESHLAR DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2218
Practice Address - Country:US
Practice Address - Phone:907-887-6269
Practice Address - Fax:907-887-6269
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA7021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDA4460Medicaid
AKAA702OtherSTATE OF ALASKA
AKMH4238Medicaid