Provider Demographics
NPI:1639116502
Name:CROSLAND, SELEAH LAVETTE (MA, LPC,NCC)
Entity Type:Individual
Prefix:MRS
First Name:SELEAH
Middle Name:LAVETTE
Last Name:CROSLAND
Suffix:
Gender:F
Credentials:MA, LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 THREE BEND RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLS
Mailing Address - State:SC
Mailing Address - Zip Code:29581-4424
Mailing Address - Country:US
Mailing Address - Phone:843-798-1158
Mailing Address - Fax:
Practice Address - Street 1:171 WACCAMAW MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8965
Practice Address - Country:US
Practice Address - Phone:843-798-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health