Provider Demographics
NPI:1710215652
Name:COLSTON, SELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:COLSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLIFTON SPRINGS MENTAL HEALTH CENTER
Mailing Address - Street 2:3110 CLIFTON SPRINGS ROAD
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034
Mailing Address - Country:US
Mailing Address - Phone:404-243-9500
Mailing Address - Fax:404-244-2224
Practice Address - Street 1:DEKALB COMMUNITY SERVICE BOARD
Practice Address - Street 2:445 WINN WAY
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-294-3742
Practice Address - Fax:404-508-7891
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical