Provider Demographics
NPI:1598896813
Name:SELLERS, KRISTIN FISHER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:FISHER
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RICHARDSONS BROOK DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-4112
Mailing Address - Country:US
Mailing Address - Phone:610-444-7297
Mailing Address - Fax:
Practice Address - Street 1:2832C CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1620
Practice Address - Country:US
Practice Address - Phone:410-688-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical