Provider Demographics
NPI:1326203928
Name:SELLERS, CARRIE A (LISW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 HIGH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8257
Mailing Address - Country:US
Mailing Address - Phone:330-227-4518
Mailing Address - Fax:855-975-3166
Practice Address - Street 1:1392 HIGH ST STE 205
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8257
Practice Address - Country:US
Practice Address - Phone:330-227-4518
Practice Address - Fax:855-975-3166
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 0700059-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0369772Medicaid