Nicole Sebastian, PSYD, CCS, CADC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6352000089 Issued in MI

Practice address

28466 Hoover Rd Apt 1
Warren, MI 48093-5419

Phone

(310) 467-6199

NPI assigned

Oct 7, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Divine Guidance Institute and Wellness Center Inc.

  • Multi-Specialty Clinic/Center
  • Warren, MI
  • NPI 1275317737
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1447401567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28466 HOOVER RD APT 1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935419",
            "telephone_number": "310-467-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28466 HOOVER RD APT 1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935419",
            "telephone_number": "310-467-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEBASTIAN",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PSYD, CCS, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-07",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6352000089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500371",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fremont Louis Scott III, DO
• Leslie Adele Scott, D.O.
• Richard A Scott, DO
• Rebecca Scribner, PHARMD
• Jasmine Seal
• Kelly Marie Sebell
• Lynzie Sehi, DC
• Dawn Catherine Seifert, CPNP
• Abby Seifman
• Vanessa Louise Selim, RN

• Psychologist in Warren, MI
• Providers in Warren, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.