Provider Demographics
NPI:1396143277
Name:SEAL, WENDELYN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:WENDELYN
Middle Name:
Last Name:SEAL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NOAH LN
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-7828
Mailing Address - Country:US
Mailing Address - Phone:601-916-0126
Mailing Address - Fax:
Practice Address - Street 1:29 NOAH LN
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7828
Practice Address - Country:US
Practice Address - Phone:601-916-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL7181101YM0800X
LA130741041C0700X
MSC77491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health