Provider Demographics
NPI:1669007845
Name:SELLARS, JOHN RICHARD (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:SELLARS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 BEAR WALLOW DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2060
Mailing Address - Country:US
Mailing Address - Phone:540-222-4669
Mailing Address - Fax:
Practice Address - Street 1:7360 BEAR WALLOW DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2060
Practice Address - Country:US
Practice Address - Phone:540-222-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional