Healthcare Provider Details

I. General information

NPI: 1124931456
Provider Name (Legal Business Name): SELAH THERAPY COLLECTIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E TECOMA LN
CLAYTON NC
27520-8785
US

IV. Provider business mailing address

247 E TECOMA LN
CLAYTON NC
27520-8785
US

V. Phone/Fax

Practice location:
  • Phone: 919-341-9196
  • Fax:
Mailing address:
  • Phone: 919-341-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. AUTUMN SCHOONOVER
Title or Position: OWNER
Credential: LCSW, LISW-CP
Phone: 919-341-9196