Provider Demographics
NPI:1730544214
Name:SELAH OF THE CAROLINAS
Entity type:Organization
Organization Name:SELAH OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-509-0293
Mailing Address - Street 1:1530 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2611
Mailing Address - Country:US
Mailing Address - Phone:803-260-2854
Mailing Address - Fax:
Practice Address - Street 1:1530 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2611
Practice Address - Country:US
Practice Address - Phone:803-260-2854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness