Provider Demographics
NPI:1346004140
Name:WARTHEN, SEQUOYAH
Entity Type:Individual
Prefix:
First Name:SEQUOYAH
Middle Name:
Last Name:WARTHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 SASANQUA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9803
Mailing Address - Country:US
Mailing Address - Phone:478-221-5522
Mailing Address - Fax:
Practice Address - Street 1:915 HILL PARK STE 100B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1929
Practice Address - Country:US
Practice Address - Phone:478-305-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health