Provider Demographics
NPI:1659030625
Name:HOOD-BANDY, SELENA (LCASA)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:HOOD-BANDY
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W VANCROFT CIR # U5
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-1170
Mailing Address - Country:US
Mailing Address - Phone:252-327-0690
Mailing Address - Fax:
Practice Address - Street 1:1812 GLENDALE DR SW # A1
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4676
Practice Address - Country:US
Practice Address - Phone:252-353-0100
Practice Address - Fax:252-364-8117
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23445101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)