Healthcare Provider Details

I. General information

NPI: 1336071042
Provider Name (Legal Business Name): DR. SALENA JUSTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 SOUTH BROAD ST SUITE B
BREVARD NC
28712
US

IV. Provider business mailing address

272 S. BROAD ST. SUITE B
BREVARD NC
28712
US

V. Phone/Fax

Practice location:
  • Phone: 201-687-9113
  • Fax:
Mailing address:
  • Phone: 201-687-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SALENA JUSTICE
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 407-310-0908