Provider Demographics
NPI:1891834479
Name:SELLERS, DEBORAH LYNN (BSW, LCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:SELLERS
Suffix:
Gender:F
Credentials:BSW, LCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 FRIENDLY ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1551
Mailing Address - Country:US
Mailing Address - Phone:907-929-3548
Mailing Address - Fax:907-929-3548
Practice Address - Street 1:249 FRIENDLY ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1551
Practice Address - Country:US
Practice Address - Phone:907-929-3548
Practice Address - Fax:907-929-3548
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK416436171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM4240Medicaid