Provider Demographics
NPI:1255887618
Name:SEWELL, KAWANDA
Entity type:Individual
Prefix:
First Name:KAWANDA
Middle Name:
Last Name:SEWELL
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 1:305 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-2713
Mailing Address - Country:US
Mailing Address - Phone:601-597-3767
Mailing Address - Fax:769-355-2337
Practice Address - Street 1:418 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4314
Practice Address - Country:US
Practice Address - Phone:601-597-3767
Practice Address - Fax:769-355-2337
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health