Provider Demographics
NPI:1609974807
Name:SOWELL, SALLY F (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:F
Last Name:SOWELL
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 QUARRIER ST
Mailing Address - Street 2:STE 303
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1826
Mailing Address - Country:US
Mailing Address - Phone:304-720-2317
Mailing Address - Fax:
Practice Address - Street 1:1207 QUARRIER ST
Practice Address - Street 2:STE 303
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1826
Practice Address - Country:US
Practice Address - Phone:304-720-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV651103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164632000Medicaid
WVSO4095151Medicare ID - Type Unspecified