Provider Demographics
NPI:1891263075
Name:SEWELL, LISA BUTLER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BUTLER
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GOLD ST NE
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4020
Mailing Address - Country:US
Mailing Address - Phone:252-206-4116
Mailing Address - Fax:252-206-4069
Practice Address - Street 1:100 GOLD ST NE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4020
Practice Address - Country:US
Practice Address - Phone:252-206-4116
Practice Address - Fax:252-206-4069
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0118051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical