Provider Demographics
NPI:1356180178
Name:DANDAN, SELENA (MA, QMHP-A)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:DANDAN
Suffix:
Gender:F
Credentials:MA, QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14033 MARBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2513
Mailing Address - Country:US
Mailing Address - Phone:703-717-1814
Mailing Address - Fax:
Practice Address - Street 1:1897 PRESTON WHITE DR STE 300
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5479
Practice Address - Country:US
Practice Address - Phone:703-589-6826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health