Provider Demographics
NPI:1427738814
Name:SELLERS, MARY (MA, LCMHCA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:M
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 BARRETT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6523
Mailing Address - Country:US
Mailing Address - Phone:919-900-7552
Mailing Address - Fax:
Practice Address - Street 1:3901 BARRETT DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6523
Practice Address - Country:US
Practice Address - Phone:919-900-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health