Provider Demographics
NPI:1073846911
Name:SELAH MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SELAH MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TWYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEREEN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:910-862-2484
Mailing Address - Street 1:1206 TWISTED HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-5216
Mailing Address - Country:US
Mailing Address - Phone:910-862-2484
Mailing Address - Fax:910-862-6121
Practice Address - Street 1:3508 CLIFFRIDGE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3292
Practice Address - Country:US
Practice Address - Phone:910-671-9070
Practice Address - Fax:910-862-6121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VEREEN AND ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL078109320900000X
NCMHL009025320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities