Healthcare Provider Details

I. General information

NPI: 1104710805
Provider Name (Legal Business Name): WISE MIND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 CHEROKEE RD
FLORENCE SC
29501-5227
US

IV. Provider business mailing address

470 HARBOROUGH CT
FLORENCE SC
29501-7531
US

V. Phone/Fax

Practice location:
  • Phone: 843-731-7231
  • Fax:
Mailing address:
  • Phone: 843-319-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY M. SELMON
Title or Position: OWNER
Credential: LPC
Phone: 843-731-7231