Provider Demographics
NPI:1477911527
Name:SEWELL, JAMES ANDREW (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:SEWELL
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3504 VEST MILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3073
Mailing Address - Country:US
Mailing Address - Phone:365-826-0423
Mailing Address - Fax:336-396-5865
Practice Address - Street 1:3504 VEST MILL RD STE 1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3073
Practice Address - Country:US
Practice Address - Phone:365-826-0423
Practice Address - Fax:336-396-5865
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11952101YP2500X
NCA11952251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477911527Medicaid