Healthcare Provider Details

I. General information

NPI: 1205264454
Provider Name (Legal Business Name): SELINA R. HUNT MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SELINA R HUNT PHD,APRN,P/MHNP-BC

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BLANDING ST STE 102
COLUMBIA SC
29201-2967
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-2500
  • Fax: 803-758-1726
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2135
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2135
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: