Healthcare Provider Details

I. General information

NPI: 1710215652
Provider Name (Legal Business Name): SELENA COLSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MEDICAL GROUP UNIT 5268
APO AP
96368-5217
US

IV. Provider business mailing address

CLIFTON SPRINGS MENTAL HEALTH CENTER 3110 CLIFTON SPRINGS ROAD
DECATUR GA
30034
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4817
  • Fax:
Mailing address:
  • Phone: 404-243-9500
  • Fax: 404-244-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004113
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: