Provider Demographics
NPI:1891430971
Name:SELLARS, CHARLES MARSHALL (LMSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARSHALL
Last Name:SELLARS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOLMES CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4800
Mailing Address - Country:US
Mailing Address - Phone:912-544-4401
Mailing Address - Fax:912-330-4319
Practice Address - Street 1:6 HOLMES CT
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4800
Practice Address - Country:US
Practice Address - Phone:912-544-4401
Practice Address - Fax:912-330-4319
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical