MEDICARE: SELAH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1295210318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELAH SERVICES, LLC

Provider Business Mailing Address
First Line	:	613 UNIVERSITY DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-3707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 INDIA HOOK RD STE 140
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1278
Country	:	US
Telephone Number	:	803-203-7433
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND THERAPIST
Name	:	RACHEL BENKLER
Credential	:	MSW, LCSW, LISW-CP
Telephone Number	:	803-203-7433

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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