Provider Demographics
NPI:1407430325
Name:SELLERS, JAMES WAYNE JR (LICSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WAYNE
Last Name:SELLERS
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 CAMDEN RDG
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1994
Mailing Address - Country:US
Mailing Address - Phone:205-807-0057
Mailing Address - Fax:
Practice Address - Street 1:616 CAMDEN RDG
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-1994
Practice Address - Country:US
Practice Address - Phone:205-807-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1676C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical