Provider Demographics
NPI:1467070128
Name:SELLS, SONSEE'RAE DOLORES (MA, LMHC, PLMHP)
Entity Type:Individual
Prefix:
First Name:SONSEE'RAE
Middle Name:DOLORES
Last Name:SELLS
Suffix:
Gender:F
Credentials:MA, LMHC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9332
Mailing Address - Country:US
Mailing Address - Phone:505-409-9303
Mailing Address - Fax:
Practice Address - Street 1:3209 CRESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9332
Practice Address - Country:US
Practice Address - Phone:505-409-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12276101YM0800X
NMCMH0206671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty