Provider Demographics
NPI:1841779618
Name:SELLERS, ELIZABETH JAMESON
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JAMESON
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 GREENES XING
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2326
Mailing Address - Country:US
Mailing Address - Phone:703-431-5142
Mailing Address - Fax:
Practice Address - Street 1:3716 GREENES XING
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2326
Practice Address - Country:US
Practice Address - Phone:703-431-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health