Provider Demographics
NPI:1952722019
Name:COX, SELENA COUMANIS
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:COUMANIS
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:SELENA
Other - Last Name:COUMANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:498 CHALAN PALASYO
Mailing Address - Street 2:
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96910-6427
Mailing Address - Country:US
Mailing Address - Phone:671-486-6680
Mailing Address - Fax:
Practice Address - Street 1:498 CHALAN PALASYO
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910-6427
Practice Address - Country:US
Practice Address - Phone:671-486-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS260031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical