Basic Information
| Provider Information | |||||||||
| NPI: | 1235438573 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORMA SELL LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3971 WOODPASS LN | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488959044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174900203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4084 OKEMOS RD | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488643258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174900203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2011 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | SELL | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5174900203 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW ACSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801035634 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.