Provider Demographics
NPI:1497264386
Name:SELMAN, MONIQUE ESTELLE (MFT)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:ESTELLE
Last Name:SELMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9147 MARION OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2262
Mailing Address - Country:US
Mailing Address - Phone:937-304-5384
Mailing Address - Fax:
Practice Address - Street 1:9147 MARION OAKS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-2262
Practice Address - Country:US
Practice Address - Phone:937-304-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61073171106H00000X
VA0717001869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty