Healthcare Provider Details

I. General information

NPI: 1356052880
Provider Name (Legal Business Name): SALENA G JUSTICE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S BROAD ST STE B
BREVARD NC
28712-3768
US

IV. Provider business mailing address

212 S BROAD ST STE B
BREVARD NC
28712-3768
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 Number35SI00683900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: