Provider Demographics
NPI:1003244302
Name:SELKIN, DENE LOGAN
Entity Type:Individual
Prefix:MRS
First Name:DENE
Middle Name:LOGAN
Last Name:SELKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4079 GLENCOE AVE # 121
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5872
Mailing Address - Country:US
Mailing Address - Phone:310-869-2992
Mailing Address - Fax:
Practice Address - Street 1:4079 GLENCOE AVE # 121
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5872
Practice Address - Country:US
Practice Address - Phone:310-869-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)